Rural Sanitation and Hygiene Programme 2012 – 2016

Terms of Reference

Evaluation of the UNICEF Viet Nam’s Rural Sanitation and Hygiene Programming 2012-2016

1 Background status of water and sanitation in Viet Nam

Over the past three decades, Vietnam has experienced significant economic growth, with its GDP expanding five-fold and per capita incomes rising to $1,908 As a result of qualifying as a lower middle-income country in 2010, international aid for development began to decline, leading to reduced technical assistance from donors In response, the Government of Vietnam has sought increased technical support from UNICEF to fulfill its commitments to the Millennium Development Goals (MDGs), aiming to eliminate open defecation by 2025 and ensure sustainable water supply for all by 2030.

For over four decades, UNICEF has supported the Government of Vietnam in Water, Sanitation, and Hygiene (WASH) programming, evolving from simply providing water points to emphasizing sanitation, hygiene, and creating an environment for universal and equitable water and sanitation coverage In the past five years, UNICEF's assistance has focused primarily on upstream efforts, influencing policy and investment decisions through best practice demonstrations, introducing innovations, and advocating for effective programs.

Vietnam has successfully achieved the Millennium Development Goal (MDG) target for water supply, with near-universal access to improved water sources However, challenges remain regarding the quality and sustainability of these water services Additionally, Vietnam has met the MDG target for sanitation, experiencing a significant decline in open defecation rates, which dropped by 38.5 percentage points from 1990 to 2015 Over the past fifteen years, the country has made notable advancements in sanitation coverage, particularly in rural areas, where access to improved sanitation facilities stands at 77.7%, and open defecation rates are as low as 5.8%.

In the Mekong Delta, 36.5% of households utilize hanging latrines that discharge waste directly into nearby water bodies, impacting over 12 million individuals This situation includes 6 million people who defecate in open fields, exposing themselves and their communities to unsanitary conditions.

Despite 6 million people gaining access to improved water bodies, 16% of the population still relies on unimproved sanitation facilities, particularly in rural households Significant disparities exist across one-third of the country's provinces, especially in the northern mountains and central highlands where many ethnic minorities live Access to improved sanitation is inequitable by income, with only 60% of the poorest quintile benefiting compared to 80-100% in other income groups While there have been improvements for the poorest, further action is necessary to elevate households up the sanitation ladder Additionally, Vietnam faces ambitious targets that require ongoing commitment and support.

‘safely managed’ water supply and sanitation targets set with the Sustainable Development Goals (SDGs)

Personal hygiene remains a concern in Vietnam, yet handwashing with soap has seen significant improvement Currently, approximately 86% of households have a designated area for handwashing equipped with water and soap However, this rate is lower in rural regions (83%), the Northern Midlands and Mountainous Area (75%), and among the poorest households, where it drops to around 65%.

The Ministry of Agriculture and Rural Development (MARD) oversees the rural water supply and sanitation program, focusing on policy, investment decisions, and sector coordination Supporting MARD at the national level is the National Centre for Rural Water Supply and Sanitation (NCERWASS), which aids in planning and implementation NCERWASS also assists MARD in developing relevant policies and strategies while providing technical support to provincial centers for rural water initiatives.

PCERWASS, operating under the Department of Agriculture and Rural Development (DARD), is tasked with the comprehensive planning, design, and implementation of rural water supply and sanitation across all 63 provinces.

The Ministry of Agriculture and Rural Development (MARD) leads the WASH sector in Vietnam, while the Viet Nam Health and Environment Management Agency (VIHEMA) under the Ministry of Health (MoH) is tasked with sanitation and hygiene responsibilities VIHEMA provides technical assistance to the 63 provincial Centres for Preventive Medicines (CPM), which are responsible for planning and implementing rural sanitation and hygiene initiatives Additionally, the Provincial Centre for Health Education (CHE) supports hygiene promotion and other critical health behaviors At the provincial level, the Department of Agriculture and Rural Development (DARD) oversees the WASH sector, with the Ministry of Planning & Investment (MPI) and the Ministry of Finance (MOF) facilitating planning and budgeting, focusing on infrastructure development and recurring expenses, respectively However, the recurring budget is often insufficient, despite the sector's high demand for investment in community mobilization and training Coordinated planning and investment remain concerns, while the Ministry of Foreign Affairs (MOFA) fosters development cooperation with international agencies.

Technical working groups, including the sanitation and O&M working groups, play a crucial role in supporting sub-sector coordination, with members from the private sector, NGOs, academic institutions, UN agencies, and the World Bank The national rural water supply and sanitation partnership oversees the coordination of sectorial agencies through these groups Several international NGOs, such as Child Fund, Church World Service, East Meets West, Plan International, SNV Netherlands, and World Vision, operate on a limited scale Additionally, UNICEF takes on a co-lead role in various coordination mechanisms, shaping the agenda and content of the technical working groups.

Provincial coordination is overseen by Provincial Steering Committees (PSCs) alongside partners like PCERWASS, PCPM, NGOs, and mass organizations However, many provinces experience weak coordination attributed to insufficient commitment and limited capacity of provincial governments, as highlighted in the Joint Annual Review of 2015.

The Viet Nam Bank of Social Policy (VBSP) offers subsidized loans for sanitation and non-subsidized loans for water projects, with mass organizations such as Women’s Unions and Farmers Unions facilitating community involvement in financing, construction, and management of these facilities However, the WASH sector continues to struggle with inadequate public funding, particularly in rural areas To address these challenges, UNICEF has supported the Government of Vietnam in securing a US$200 million soft loan from the World Bank, aimed at improving rural WASH infrastructure in 21 underdeveloped provinces over the five-year period from 2016 to 2020, where issues of inequity and sustainability persist.

The rural WASH monitoring system, supported by UNICEF, DFAT, and DANIDA, is integrated into the national target program However, it faces significant limitations, including inconsistencies with global MDG definitions and a lack of data on the functionality and usage of water and sanitation facilities.

W ASH services The newly defined monitoring indicators for SDG targets is going pose further challenge Therefore, there is a need to overhaul the monitoring system

Overview of UNICEF rural sanitation and hygiene programming

Since 2008, UNICEF has implemented community approaches to total sanitation (CATS) and sanitation marketing (SanMark) in collaboration with VIHEMA and provincial CPMs, successfully triggering over 800 villages and achieving over 400 Open Defecation Free (ODF) villages in seven focus provinces The CATS approach also incorporates handwashing promotion, while UNICEF has advocated for low-cost improved sanitation options to accommodate the poorest communities, leading the Ministry of Health (MoH) to recognize the success and begin scaling up CATS and SanMark nationwide This includes the introduction of national guidelines for ODF verification and certification; however, challenges regarding the sustainability of ODF remain prevalent, similar to issues faced in other countries.

Under UNICEF’s 2012-2016 country programme in Viet Nam, the WASH programme aims to enhance the quality and management of the national health system The objective is to promote health and protection, prioritizing equitable access for vulnerable and disadvantaged groups by 2016.

Under this outcome, the rural sanitation and hygiene is reflected in the following ‘outputs’ at national and sub-national levels. 

Output 4 (National WASH): By 2016, identified beneficiaries benefit equitably from increased access to sustainable and hygienic sanitation and water supply

Evaluation Matrix

Key Evaluation Questions (Modified) as provided in

ToRs Key Indicators Data Collection

UNICEF's Rural Water, Sanitation, and Hygiene Programme (RSHP) has been crucial in addressing the specific needs of rural communities by enhancing access to quality water supply, promoting hygienic sanitation, and encouraging personal hygiene practices such as handwashing with soap The program aligns with national priorities and leverages existing local capacities while collaborating effectively with other sector partners to create a sustainable impact on public health and well-being in these areas.

 % of rural population having access to (government approved numbers) clean water, hygienic sanitation, and practicing handwashing with soap, in particular 7 provinces where UNICEF extended technical and financial assistance;

 Evidence of poor rural water supply, hygienic sanitation and hygiene’s impact for women and children in particular e.g health, economic, education and others

 Evidence of rural water supply, hygienic sanitation, and handwashing with soap as national priority in terms of sector plans and allocation of resources

 Evidence of adequate focus of both public and sector partners to address needs of most vulnerable groups e.g ethnic minorities, people from remote regions and Mekong delta

Stakeholders recognize UNICEF’s technical assistance as vital for empowering public entities to formulate effective sector policies, standards, and plans This support also fosters innovation, scaling initiatives like SanMark, enhances capacity development, and strengthens sector coordination.

 Stakeholders’ views of appropriateness of UNICEF technical assistance delivery approach

 Stakeholders’ views of state of sector coordination across public agencies and sector partners and areas of improvement/assistance

 Availability of Programme TOC and assessment of logic/pathways of change

 Stakeholders’ views of policies, plans and practices being informed of equity considerations including disaster and climate change risks

- MoH (national & provincial level), VIHEMA, MoF, WSSP Provincial Steering Committees and working groups

- Selected CHE, CPM< DARD, MARD

- UNICEF and other WASH sector experts;

EQ2: To what extent has UNICEF technical assistance effectively contributed to creating an enabling WASH

Governance environment (policies, strategies, national M&E systems and Stakeholder coordination) for rural water supply, hygienic sanitation, and handwashing with soap?

The article discusses the formulation, revision, and approval of various national and subnational policies, plans, training materials, and standards that focus on rural water supply, hygienic sanitation, and handwashing with soap These efforts aim to promote behavioral change and enhance public health in rural communities.

Recent efforts have intensified to enhance the operations and maintenance (O&M) of rural water supply schemes, emphasizing water safety through improved treatment and storage methods This includes the implementation of new policies and practices, increased financial investments in O&M, greater involvement of the private sector, and robust monitoring and accountability measures.

 Introduction of new approaches, plans, training contents, and practices and/or strengthening of existing approaches for rural (hygienic) sanitation and hygiene education e.g handwashing with soap;

 Availability and implementation of new BCC/C4D approaches and actions plans for low cost high impact behavioural interventions for water safety, latrine use, and handwashing with soap

 Improved monitoring (including resources) and data management and use of monitoring data/analysis for decision making

Recent policies and practices increasingly prioritize equity, disaster risk reduction, and climate change considerations, particularly for marginalized groups such as the impoverished, ethnic minorities, and remote communities.

Stakeholders emphasize the significance of research and development in creating innovative and affordable technologies for rural water supply, particularly in water treatment and storage, as well as hygienic sanitation solutions They highlight the importance of assessing the current utilization of these technologies to ensure effective implementation and sustainability in rural communities.

 New coordination forums created, and/or existing coordination forums strengthened at national and sub-national levels e.g rural sanitation, O&M, and PPP others;

- Relevant Government Departments as mentioned above

- Programme related staff (Sanitarians/frontline workers, entrepreneurs; masons, religious leaders)

UNICEF has significantly enhanced public-sector leadership in delivering essential water safety and hygiene initiatives Their efforts have led to improved knowledge, attitudes, and practices regarding critical behaviors such as handwashing with soap and proper latrine use By focusing on these key areas, UNICEF has contributed to better health outcomes and increased awareness of hygiene practices in communities.

 Change in numbers/percentage of rural households (from 2012 to

2016) for rural households reached out through water safety education campaigns and have understood and apply hygiene behaviours (stop

OD, latrine usage and maintenance, handwashing with soap) water safety practices i.e better treatment and storage practices;

 Evidences of progress made in terms of villages triggered, declared or certified, new latrines built/upgraded, and people reached out with improved BCC/C4D campaigns

 Change in numbers of people reported sick and sought health advice for water borne diseases and those linked to unhygienic practices

 Evidence of decrease in water-borne diseases including stunting (in children) in ODF certified communities and those where water safety practices are common

- Post-KAP Household Survey (HHS)

- Programme related staff of the UNICEF, IPs, NGOs/VBOs, (Sanitarians/ frontline workers, entrepreneurs; masons, religious leaders)

EQ4: To what extent the level of achievements (outputs and outcomes) justify the financial and human resources used?  Stakeholders’ views of timely completion of UNICEF interventions

 Proportional costs across intervention areas i.e water safety, ODF, and HWWS

 Costs per beneficiary for water safety, ODF, and HWWS

- Project Financial records/reports and Government Departments

EQ5: To what extent did the ODF status and the associated social norm as well as hand washing practices are likely to sustain?

 Evidence in relation to planning, executing and use of a sustainability compact Post-ODF capacities and monitoring mechanisms at community level and within Government system

 Evidences of ODF/CLTS implementation integrating social norms creation and post ODF monitoring and reporting

 % of ODF verified/certified communities that are maintaining ODF its ODF status one year after /verification/certification

Evidence shows that the status of Open Defecation Free (ODF) areas can deteriorate over time, as indicated by the prevalence of latrine existence and usage Additionally, the study highlights the influence of both empirical and normative expectations on latrine use, revealing a correlation between these expectations and actual latrine utilization rates.

 Stakeholders’ views of achievements that shall sustain beyond RSHP completion e.g policies, plans, standards, training materials and trained human resources, innovative products, and others

EQUITY, GENDER, DISASTER AND HRBA

To effectively address the needs of vulnerable and marginalized groups, such as the poor, remote communities, ethnic minorities, women, children, the elderly, and people with disabilities, RSHP projects adopted inclusive strategies that prioritized community engagement and tailored interventions By fostering collaboration with local stakeholders and implementing targeted outreach programs, these initiatives successfully integrated the voices and needs of these groups into project planning and execution As a result, significant improvements in access to resources, enhanced social support systems, and increased participation in decision-making processes were achieved, ultimately leading to more equitable and sustainable outcomes for all affected communities.

- Evidences and stakeholders’ views of RSHP projects and interventions prioritizing the under-developed regions and vulnerable groups for support

- Evidences of RSHP advocating prioritization of poor, disabled, women and children, and minority groups in national and sub-national policies and plans

- Stakeholders’ views of RSHP strategies and interventions prioritizing vulnerable groups (poor, minority groups, hard to reach communities, and others)

- Evidences and stakeholders’ views of results tracked and reported for poor, disabled, women and children, and minority groups

Sampling Frame (Sampling Rationale and Strategy)

The Household survey aims to provide a representative assessment of WASH interventions, specifically focusing on post-ODF latrine usage and handwashing practices for evaluating social norms within the targeted communes.

This study aims to accurately predict the relevant proportion of the universe by utilizing a parsimonious and representative sample, which is crucial for understanding population parameters In the absence of specific data on population size or household numbers within each commune or village, and by assuming a normal distribution of the total population, the sample size calculation remains unaffected by the overall population size To determine the optimal sample size, we base our calculations on a designated margin of error, a confidence level, and a baseline indicator level Specifically, we have calculated the sample size using a 95% confidence level and a 5% margin of error, as detailed in the accompanying table that outlines the parameters used in the formula.

Describes the level of uncertainty in the sample mean or prevalence as an estimate of the population mean or prevalence Recommended value: 1.96 (for 95% confidence level)

The expected half-width of the confidence interval The smaller the margin of error, the larger the sample size needed Recommended value: 0.05 Baseline levels of the indicators

The estimated prevalence of risk factors in the target population is crucial for accurate analysis When no prior data is available, a conservative estimate of 0.5 is recommended, as it reflects values closest to 50% If previous data exists, the value should be adjusted to the nearest figure to 0.5 The calculation employs a formula where LOC is set at 1.96 for a 95% confidence level, with a margin of error (MOE) of 5% and an index (Ind) of 0.5.

Sample Size (n) = LOC 2 x Ind x (1 – Ind)

To mitigate methodological errors and biases, the Consultants recommend increasing the sample size by about 5% of the total calculated figure, resulting in a proposed total sample size of 400 households for the Household Survey.

List of Randomly Selected Triggered, Verified and Declared Districts

The villages listed in the table were selected from the Triggered, Verified, and Declared (TVD) categories within specific districts and provinces These districts and provinces were randomly chosen from areas with a predominance of TVD villages It is important to note that the district of Hồng Ngự has been substituted with Thuận Bắc due to government feedback regarding health-related security risks.

E# Region RS Province District Village CLTS check Rand

2 C S1 Ninh Thuận Thuận Bắc Ba Tháp TVD 0.233

34 N S1 Lào Cai Bắc Hà Cốc Môi TVD 0.110

E# Region RS Province District Village CLTS check Rand

40 Lèng Phàng –Làng Mương TVD 0.482

120 S S1 Đồng Tháp Hồng Ngự Phú Lợi A TVD 0.249

List of Selected Districts in the Target Population

Table 1: List of sampled provinces, districts and villages

Province District Commune Village TVD flag Rand Đồng

Tháp Tân Hồng TT Sa Rài Khóm 1 123 0.639

Xã An Phước An Phát 123 0.208 Án Thọ 123 0.214

Xã Bình Phú Gò Da 123 0.682

Xã Tân Phước Hoàng Việt 123 0.597

Tân Bảnh 123 0.523 Lào Cai Bắc Hà Bản Phố Háng Dê 123 0.125

Thuận Bắc Bắc Phong Ba Tháp 123 0.233

Giác Lan 123 0.927Hiệp Kiết 123 0.875Hiệp Thành 123 0.675Lợi Hải Kiền Kiền 1 123 0.616

Inception Phase Data Collection Format

This document provides a collection of formats designed to organize the data and information required for evaluation These formats can be utilized directly or serve as a guide for outlining specific needs Each format is accompanied by an explanatory note, and additional relevant information can be included as necessary.

Format 1: Overview/Status of Availability of Information / Datasets

Type of Information / Dataset Availability Status

The article outlines key components of a comprehensive program evaluation, including a Baseline Survey and a Mid-term Survey to assess progress It emphasizes the importance of Monitoring Data to track ongoing developments Additionally, it provides a list of ODF (Open Defecation Free) certified villages and communes, along with a district-wise roster of staff involved in the implementation process Contact information for District Level Programme managers is also included, alongside a list of Village Sanitation Committees (VSC) established during the program and a directory of sanitary marts and entrepreneurs participating in the initiative.

Explanatory note: a list of datasets (generated by various kinds of contracts, monitoring systems and tools) that are available and relevant to the evaluation)

Questionnaire for the Household Survey

RSHP Evaluation - Household Survey Questionnaire

Project Name RSHP Viet Nam Type of questionnaire Post-KAP Survey

AAN Associates Pakistan Address: 108, Executive Heights, F-11/1, Islamabad, Pakistan www.aanassociates.com

RECORD OF INTERVIEW Name of Interviewer/

Day of the Week Mon 1 Tue 2 Wed 3 Thu 4 Fri 5 Sat 6 Sun 7

Date of Interview Date Month Year Time Began Time Ended Total Length of

Hello, my name is , and I am collaborating with DEPOCEN and AAN Associates in Pakistan on behalf of UNICEF, Country Office, Vietnam We are conducting a survey to gather information from households regarding Water, Sanitation, Hygiene, and Health conditions Your household has been selected for an interview, and we greatly value your participation The data collected will assist UNICEF and the Ministry of Health in planning and evaluating a sanitation project in your area The survey will take approximately 45 minutes, and all information provided will remain confidential and anonymous, shared only with our project team Participation is voluntary, and you may skip any questions you prefer not to answer or discontinue the interview at any time Your input is crucial to our research, and we sincerely hope you will participate.

Do you have any questions about the survey at this time?

May I begin the interview now?

IF RESPONSE IS NO – THANK THE RESPONDENT AND STOP INTERVIEW

G1 Name of Province – Circle Answer (SA) G2 Name of District - Circle Answer (SA)

G5 Name of Head of Household

G6 Sex of the Head of Household Male 1 Female 2

G7 Age of a Head of household

G8 Ethnic group (of the Head of the

G9: What is your relationship to the Head of Household? (SA)

Self - Head of Household 1 Father-in-law 10

STOP INTERVIEW AND SAY THANK Daughter-in-law 8 Not Related 17 YOU

When conducting interviews, priority should be given to the head of the family or the housewife If they are unavailable, interviews may be conducted with other family members aged 18 and older who possess the most knowledge about the interview topic.

G10: The confidentiality statement has been read to me I understand it and give my verbal permission to proceed with the interview (SA)

No 2 STOP INTERVIEW AND SAY THANK

I1: May I know your current age?

INTERVIEWER: THE RESPONDENT IS ELIGIBLE FOR INTERVIEW IF HIS/ HER AGE IS ≥18

I3: How many people live/or stay in this house today? Not including guest or relatives who stayover for a few days

I4: Now I’d like to know in detail the age and sex of people living in your household today, but not including guest or relatives who stay over for few days

During the interview, gather data for each age group and gender by recording responses in the designated columns Ensure to tally the total number of individuals residing in the household for accurate results.

BE THE SAME AS THE ONE MENTIONED IN I3

I5 What is the highest level of schooling you completed? (SA)

I6: Does your household own any of the following items? (MA)

READ AND ASK FOR EACH ITEM - MULTIPLE ANSWERS

Motorcycle/scooter 6 Own farm animals 12

I7: What is Average monthly income from all sources, of your households? (SA PER CELL)

ASK FOR SPECIFIC ANSWER I.E NOT A RANGE OF AMOUNT

Which of following activities are your household income sources in 2016?

99 Do not know/ Refuse to answer

If yes, total Income in 2016

5 Processing agricultural products; Trading; and small business

ND1 Did your village/family experience any natural disaster/s during last two years, which may have caused destruction (including water sources) and human/economic losses?

ND1A If Yes, Please specify;

READ OUT “NOW I WANT TO ASK YOU ABOUT ACCESS TO WATER FOR YOUR FAMILIES USE”

W1: What is your current primary source of water for drinking and cooking? (SA)

CIRCLE ONLY ONE PRIMARY SOURCE

Piped into dwelling, plot or yard 1.1 Unprotected dug well 2.1

Public tap/standpipe 1.2 Unprotected spring 2.2

Tube well/borehole 1.3 Cart with small tank/drum 2.3

Protected dug well 1.4 Bottled water 2.4

Rainwater collection 1.6 Surface water (river/dam/lake/pond/stream/canal) 2.6

Other (specify) 88 W1A: Do you always have access to this drinking water source year-round? (SA)

W1B: Is the drinking water from your main source clean?

When assessing the quality of drinking water from your primary source, consider three key factors: taste, odour, and appearance For each factor, respondents can indicate their perception by selecting from the following options: "Yes," "No," or "Don't know." This structured feedback will help evaluate the overall acceptability of the water quality.

W1C: Is the drinking water from your main source safe?

W2: What is your current main source of water for bathing, toilet flushing, cleaning etc.? (SA)

W3: Do you always have access to this water source for household needs (bathing, toilet flushing, cleaning etc) year-round? (SA)

W3A: If NO, when do you NOT have access to this water source? (SA)

W3B When this source is not available, what other main sources do you usually use? (SA)

W3C: Is your current main source of water for bathing, toilet flushing, cleaning etc clean?

W3D: Is your current main source of water for bathing, toilet flushing, cleaning etc safe?

WSS Is Water Supply Scheme available in your commune/ village?

W4 Who manages/operates (takes care of operations and maintenance of water source) the Water Supply Scheme (for drinking water) in your village?

Note: For those villages/households where the water is provided by the public sector/private sector piped water schemes and others

Provincial Agriculture & Rural Development Depart 1

Village Water User Committee/Group 2

W5 Is a trained technician/plumber available locally (within village or neighbouring village) to operate and undertake minor repair/maintenance of Rural Water Supply Scheme?

W5.1 Are commonly used spare parts for Rural Water Supply Scheme available locally (in the village or neighbouring village)?

W6 Is loan (facility) available to install and/or major repair/upgrade Rural Water Supply Scheme?

W6A If ‘Yes’ who provides the loan?

W7 Are there charges in your village to access water from a Rural Water Supply scheme?

W7.1 If someone in your village did not pay to access water from the water supply scheme, what would happen to them? (MA)

W7.2 How are people punished for not paying for access to water from the water supply scheme?

Ask this question ONLY IF, Water Tariff/payment system exists in village

W8 How much do you pay for getting water (for all purposes) per month? VND _

If household pays water tariff,

W8A Who do you pay to access water?

If household pays water tariff,

Fixed water tariff (monthly/daily) 1

W8.1 Did Government/Private Contractor/Water User Committee consult the community while setting water tariff/fee?

W8.2 Are subsidies/discounts available to these groups (from water tariff/fee)? (MA)

No exemptions/subsidies for any group 5

W9 How many times was Water Supply Scheme non-functional (broken down) during the last six months? Write number: _ (-99 Don’t Know)

W9.1 How long does it usually take to repair (make functional) in case of breakdown of Water Supply Scheme? (MA)

Over a week but less than month 5

W9.2 Does the WSS remain functional (continue to provide water) during natural disasters (drought, floods and others)?

W10 Did you receive awareness message for water storage/treatment in last one year?

W10A If ‘Yes’, are message/s understandable to the following (MA)?

Illiterate (having no formal education) 3

W11 Do you treat drinking (water) in any way to make it safer to drink?

W12 What do you usually do to make the water safer to drink? (MA)

Use a water filter (ceramic, sand, composite, etc.) 4

Let it stand and settle 6

W13 How drinking water in your household is stored?

(What type of containers you use for drinking water storage?)

READ OUT - “NOW I WANT TO ASK YOU SOME QUESTIONS ABOUT THE TOILET FACILITY YOUR

S1: Does your house currently have a toilet? (SA)

During the interview, inquire whether the household has a toilet facility and request to see the specific toilet that family members typically use Conclude the interview by completing the observation questions and documenting the type of latrine available.

S2 – S7 IF HOUSEHOLD HAS FACILITY ASK THESE QUESTIONS

S2: Do you share this facility with other families outside of your home? (SA)

No Facility only used by my household 1 GO TO S3

Yes Shared 2 GO TO S2A S2A: If shared, how many families use this toilet/WC facility?

S3: Why does your family use a toilet facility? (MA)

DO NOT READ OPTIONS OUT LOUD CIRCLE ALL RESPONSES

For good health/disease prevention 1 To avoid disturbing others 8 Cleaner and healthier living in our home 2 To avoid embarrassment/humiliation 9

Convenience 3 It’s what everybody is doing 10

To have privacy when use the facilities 4 We were told it was the right thing to have 11

To be modern 5 Don’t know 99

To be accepted well by others (pride/status) 6 Other (specify) 88

To avoid sharing with others 7

S4: Which members of your immediate family usually DO NOT use this toilet? (MA)

Member Use DO NOT use

S5: How often do members of your immediate family use this toilet to defecate when at home? (SA PER ROW)

Usually / Mostly Always Don’t know

Children five years and younger 1 2 3 4 99 6

Elderly 60 years old and older 1 2 3 4 99 6

ES1 What type of toilet does your household have? (SA)

INTERVIEWER: SELECT APPROPRIATE ANSWER BASED ON THE DESCRIPTION PROVIDED BY THE RESPONDENT

Flush Toilet (2) Pit Latrine (3) Insanitary latrine

Flushed to piped sewer system

4.1 Refused/Not able to observe

Pit latrine with slab (concrete, wood/bamboo) 2.2 Other

Pit latrine without slab/open pit

ES2: When did your household construct latrine FIRST time? (Record estimated year, month or both) (SA)

ES3: Have you improved/upgraded this latrine in last THREE years? If yes, when did it happen? (SA)

ES4: What is your major reason for improvement/upgrading? (SA)

Construction is poor 1 Toilet location is inconvenient to use 2

Water is not available close to the toilet 3

Too many household members for one toilet

(i.e not available when you try to use it) 4

Toilet is dirty / dark / smelly 5

Other (specify) 88 Don’t know 99 ES4.1: What do you think about quality of this latrine construction? (SA)

ES5: Are you aware of any available options to receive any assistance (loan, financing, gifts/grants,

Construction Material/in- kind support etc.) to help you build the latrine? (SA)

Don’t know 99 GO TO ES7

ES6: Did you receive any assistance (loan, financing, gifts/grants, Construction Material/in- kind support etc.) to help you build the latrine? (SA)

Don’t know 99 GO TO ES7

ES6.1 What type of Assistance you received? (MA)

Please specify the kind/type of Loan? (for example, cash)

Grant / Gift / subsidy 2 Please specify the kind/type of Grant/Gift/subsidy? (for example, cash, cost- sharing, free labour cost of the mason) Specify:

Please specify the kind/type of support? (for example, sanitary material, free labour cost of the mason)

ES7: How much did you spend (in total) on constructing your toilet? (SA)

ES7.1 Out of this, how much of this was subsidised (in cash or kind)? (SA) VND _

S7: Who in your family made the decision to have a latrine built for your household? (MA)

DO NOT READ OPTIONS OUT LOUD CIRCLE ALL RESPONSES

In our household, the male head of the family takes on the primary responsibility for latrine maintenance, while the female head of the family also contributes to its upkeep The latrine was already present in the house when we moved in, and there is no additional information regarding its previous condition When asked about who regularly cleans the latrine, responses varied, with some family members unsure or choosing not to disclose.

Boys 1 Girls 2 Women 3 Men 4 Other (specify) 88 Don’t know 99 TM2 How often latrine in your household is cleaned?

SKIP TO S12 AFTER COMPLETING TM2

IF HOUSEHOLD HAS NO FACILITY ASK THESE QUESTIONS S8 – S11

DO NOT READ OPTIONS OUT LOUD

S8: You said you had no toilet facility in your house, where do you and members of your family defecate most of the time? (MA)

Bush/Field 1 Behind our house 6

S9: What keeps your family from having a toilet facility at your home? (MA)

No materials to construct 2 Not enough water available 3 Don’t know how to construct 4 Don’t like the latrines I’ve seen constructed 5 Not interested/Prefer to use what we currently do 6

No land/space available to construct/Unable to construct on our land (renter, rocky soil/flood plain, not enough land, etc.) 7

Waste feeds fish/other animals 8

Don’t know/Refused 99 Other (specify) 88

10: If you decide to construct a latrine, do you know approximately how much it WILL cost you to construct your preferred type of latrine? (SA) Amount: (VND)

ASK FOR BEST GUESS BY GIVING ONE PRICE, NOT A RANGE)

S11: Are you aware of any available options to receive any assistance (loan, financing, gifts/grants,

Construction Material/in-kind support etc.) to help you build the latrine? (SA)

S12: What do you do with the stools of babies and young children (ages 0-5)? (MA)

Thrown in toilet facility/latrine 1 Thrown in the bushes/field/animal pen river/beach/drain 2 Not disposed of/left on the ground 3

Buried in yard/field 4 Thrown in garbage/rubbish bin 5

N/A household does not have young children this age 7

Community Participation and Communication Channels

In the past five years, has any family member attended a sanitation meeting, or has a government representative, such as a sanitarian, visited your home to discuss the construction of a latrine?

CC1a: Did you receive sufficient/useful information (awareness messages, supplies, mason etc.) to help to construct a latrine at your home?

No 2 Don’t know 99 CC2b: Can you recall THREE key messages, which you have learned and/or learned and practice due to your participation in that meeting/activity?

CC3: What are the sources of information through which you get information about hygiene and toilet?

DO NOT READ OPTIONS OUT LOUD CIRCLE FIRST, SECOND AND THIRD RESPONSES IN EACH

COLUMN ONLY ONE ANSWER PER COLUMN

Print Materials (posters, leaflets, etc.) 3 3 3

From School Children in the family 5 5 5

Local authority (head of village) 7 7 7

Government health workers (local health workers, etc.) 9 9 9

Sanitary Mart/Shop, local Mason 10 10 10

Mass organisation (e.g Women’s Union, Farmers’ Union, Youth

CC4: Which sources of information you trust/prefer the most than others?

DO NOT READ OPTIONS OUT LOUD CIRCLE FIRST, SECOND AND THIRD RESPONSES IN EACH

COLUMN ONLY ONE ANSWER PER COLUMN

Print Materials (posters, leaflets, etc.) 3 3 3

From School Children in the family 5 5 5

Local authority (head of village) 7 7 7

If ‘YES’, please specify any Three key messages; (Probe for stop open defecation, Construction/maintenance of latrine, continued use of latrine, any other

Government health workers (local health workers, etc.) 9 9 9

Sanitary Mart/Shop, local Mason 10 10 10

Mass organisation (e.g Women’s Union, Farmers’ Union,

Questions about CATS/CLTS processes

The Village Sanitation Committee or Association plays a crucial role in promoting sanitation within the community, focusing specifically on the availability and sustained use of latrines This organized group of active volunteers and community members is dedicated to continuous efforts in improving sanitation practices.

Don’t know 99 GO TO CP3

The indicator measures the participation levels of various community members, encompassing men, women, children, individuals with disabilities, those from the poorest households, minority groups, decision-makers, opinion leaders, and the elderly A high or low percentage reflects the inclusivity and engagement of diverse demographics within the community.

CP1a: Who are the members of Village Sanitation Committee/Association (Please mark all those represented in the group/committee)?

4 Boys 5 People from Poor households 6 Elderly people

7 Village leader 8 People with disabilities 9 People from Minority groups

CP2: Do you know, if this community has Sanitation Action Plan to achieve ODF (post-triggering action planning and activities/actions) and for maintaining the ODF status? SA

Don’t know 99 GO TO CP 3

CP2a: Who were the key actors/groups involved in developing this Sanitation Action Plan? (MA)

General Community members were involved 1

Community based sanitation forum/committee or group of volunteers 2

Government Department (health facility staff etc.) 3

UNICEF or its partners staff/team 4

Other NGO/CBO was involved Specify the name 5 Name:

CP2b: Which key actor/group was in the MAIN LEADERSHIP role for developing the community action plan? (SA)

Community based sanitation forum/committee or group of volunteers 2

75 SUSTAINABILITY CHECKS - guidance to design and implement sustainability monitoring in WASH: UNICEF HQ Programme Division/ WASH, New York; UNDP-SIWI Water Governance Facility, Stockholm

Government Department (health facility staff etc.) 3

UNICEF or its partners staff/team 4

Other NGO/CBO was involved Specify the name 5 Name:

CP3: Have you ever seen any map or sign in your community to stop open defection?

CP4 Are you aware if this community is verified as ODF verified community? If yes, do you know when did community achieve ODF Verification?

Don’t know 99 GO TO CP5

CP4A: Do you know if your community as a whole received any reward or incentive for achieving ODF status? (Positive reinforcement of rules, instructions, commitments)

CP4B Do you know, if after the ODF verification, anyone come to your household/village to follow-up and share the message/s of keep using/improving the toilet?

CP4C Do you know if community members are involved in maintaining/sustaining the ODF status (post-

CP5 Where can sanitary materials and supplies for constructing toilet be purchased? (Single Answer)

Within or nearby your village/community 1

At district level 3 Don’t know 99

CP6 How do you rate the quality of the sanitary supplies (pipe, commode, etc.) and other construction materials required to build/maintain latrine?

IF ‘YES’ Please specify the type of reward/incentive awarded to your community? (Multiple answers)

3 In-kind or material support

4 Any other Incentive or reward Specify:

CP7 What do you think about the pricing of the commonly available/used sanitary materials/supplies?

Costly 2 Very Cheap (most economical) 5

Diarrhoea Knowledge/Practice/Child Health

To protect young children aged 0-5 against diarrhoea, consider implementing several effective strategies Ensure that children have access to clean and safe drinking water, as hydration is crucial Encourage proper handwashing with soap, especially before meals and after using the toilet, to reduce the risk of infections Provide a balanced diet rich in fruits, vegetables, and probiotics to support gut health Regularly sanitize toys and surfaces to minimize germ exposure, and educate caregivers about the importance of vaccinations that can prevent diarrhoeal diseases Lastly, seek prompt medical attention if a child shows symptoms of diarrhoea to ensure timely treatment and care.

Boil or treat your water 1 Use latrines/dispose faeces of children in latrines 2

Wash hands with soap and water 3

Cook food well 4 Store food properly/ cover the food 5 Buy food from a clean place/ not buying food from random place 6

Wash fruits and vegetables with potable/safe water 7

There is nothing you can do, it’s a normal part of life 8

ASK ONLY IF HH HAS YOUNG CHILDREN ≤ 5 – SEE I4

In the last two weeks, has your child or children under five experienced diarrhoea, characterized by three or more watery stools within a 24-hour period or the presence of blood in the stool?

READ OUT: “NOW I WANT TO ASK YOU SOME QUESTIONS ABOUT HAND WASHING”

HW1: When do you wash your hands? (MA)

When they are visibly dirty 1 When they smell or are sticky 2

Before cooking 3 Before eating 4 Before feeding a baby/child 5

After defecation 6 After cleaning a baby that has defecated 7

Does not wash hands 9 GO TO HW6

HW2: What do you usually use to wash your hands? (MA)

Soap 1 Powdered or liquid detergent 2

Do not use anything (cleansing agent) to wash hands 5 GO TO HW4

HW3: When do you usually use soap, powder/liquid detergent, ash, dirt/sand/mud or other material to wash your hands? (MA)

When they are visibly dirty 1 When they smell or are sticky 2

Before cooking 3 Before eating 4 Before feeding a baby/child 5

After defecation 6 After cleaning a baby that has defecated 7

After work 8 Don’t know 99 Other (specify) 88 HW4: Can you share why you wash your hands (what motivates you to wash your hands)? (MA)

To prevent the spread of disease 1

To get rid of dirt/smell/sticky things on my hands 4

Religious reasons/beliefs 5 Was told it was the right thing to do 6 Because that’s what everyone does 7

IF THE RESPONDENT ANSWERED OPTION 2 OR 3 IN HW2 (WASH HANDS WITH SOAP OR

POWDERED / LIQUID DETERGENT) THEN ASK HW5

HW5: You said you use soap/powdered or liquid detergent to wash your hands, do you have any in your home today? (SA)

IF YES ASK “CAN YOU PLEASE SHOW IT TO ME” AND OBSERVE

IF THE SOAP/POWDERED OR LIQUID DETERGENT TO WASH HANDS IS AVAILABLE AT THE TIME OF INTERVIEW THEN CIRCLE CODE 1 (YES)

IF THE SOAP/POWDERED OR LIQUID DETERGENT TO WASH HANDS IS NOT AVAILABLE AT THE TIME

OF INTERVIEW THEN CIRCLE CODE 2 (NOT AVAILABLE)

IF RESPONDENT DOES NOT WASH HANDS (CODE 10 AT HW 1) ASK

HW6 You said that you do not wash your hands Can you share the reasons why you don’t wash your hands? (MA)

No/insufficient water to wash hands 1

No soap available to wash hands 2

No ash available to wash hands 3

Don’t understand the purpose/not important 4

Don’t have time to 5 Don’t know when to 6 Don’t know 99 Other (specify) 88

SHOW CARD AND READ OUT THE FOLLOWING:

The card presented features five boxes, ranging from "Strongly Disagree" on the left to "Strongly Agree" on the right Each statement will be accompanied by cue cards that clarify what each box signifies Participants will be asked to share their opinions on statements regarding toilet use and handwashing practices If you agree with any statement, please indicate your level of agreement by pointing to the corresponding box on the right.

To express your opinion on the statement, please indicate your level of agreement by selecting one of the boxes provided Choose "Agree" or "Strongly Agree" if you support the statement, or "Disagree" or "Strongly Disagree" if you oppose it If you have a neutral stance, please select the box in the center Let's begin with the first statement.

CIRCLE ONLY ONE ANSWER FOR EACH ATTRIBUTE

READ OUT THE FOLLOWING STATEMENT: HOW FAR DO YOU AGREE OR DISAGREE THAT ……… (GO

R1 A lot of people think it is too expensive to have a toilet in their house 1 2 3 4 5

R2 It’s embarrassing when community members can see other people defecating in the open 1 2 3 4 5

R3 Many people don’t want to build a toilet in their house because it smells 1 2 3 4 5

R4 There is no relationship between defecating in the open and people having diarrhoea

R5 Most people think that it is necessary to wash their hands with soap especially after defecation

R6 You only need to wash your hands when they look/feel dirty 1 2 3 4 5

SN1 Some people use a latrine and other people do not

How often do ALL members of your household use a latrine?

Note: The overall response to ‘options-5’ will indicate the slippage rate

Consider the habits of those in your community, including family, friends, and neighbors Reflect on the number of individuals, out of ten, who believe that all their family members consistently use a latrine This assessment highlights the importance of sanitation practices within your village.

SN3 Do you believe that people in your village should use a latrine? 1 Yes

2 No – GO TO SN4 SN3.1 Why do you think people in your village should use a latrine? 1 Because it is the right thing to do

2 Other reasons (please specify – record only 2 max)

In your village, consider the opinions of your family, friends, and neighbors regarding the importance of using a latrine Out of every ten individuals, how many believe that using a latrine is the right and responsible choice for maintaining hygiene and public health?

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