Bringing safe, clean water to highland communities in Ratanakiri province, Cambodia

Introduction

75% of men, women and children in Ratanakiri are at risk of disease due to dirty, contaminated water.
Drinking polluted water is a direct contributor to diarrhoea, one of the main causes of infant mortality in
Ratanakiri. As a response to this urgent need Health Unlimited has worked in consultation with
communities in Ratanakiri to develop a new water and sanitation project.

The project will ensure sustained access to appropriate quality water for 29 villages in Ratanakiri
province.
As well as the construction of water points in areas of acute need Health Unlimited plans to pioneer a
spares and maintenance system for the province that will ensure the long term sustainability of
construction work.
Community organisers will work with communities to enhance hygiene and sanitation practices. This
will be process of constructive dialogue that will ensure ownership of new practices and
complimentarily with existing traditional beliefs.
The project will also improve school sanitation in 8 schools near target villages. Evaluations have
shown that improving school sanitation leads to greater attendance by girl students and saves time for
all students attending school.

The project will work with communities from the main ethnic groups of Ratanakiri including Kreung,
Jarai, Brao, Tampoen and Khmer.

This proposal will complement the Royal Government’s Cambodia Millennium Development Goals to
increase the proportion of the rural population with access to safe drinking water to 50% and improved
sanitation to 30% by 2015.

Objectives/ Aim

To improve health among indigenous highland populations in Ratanakiri

To ensure sustained access to appropriate quality water and enhance hygiene and sanitation
practices in highland communities in Ratanakiri province, Cambodia

Problem analysis
Between 2004 and 2007 Health Unlimited commissioned a number of studies.

The most relevant problems identified in the studies include:

Villages have limited access to year around adequate, safe and available water sources.1
Many traditional water sources, such as rivers, streams and springs are a long way from the village,
over difficult terrain. Hand dug wells have limited water supply in the dry season. Villagers
demonstrate little ownership of donor provided ring wells and they were not always consulted during
the design and implementation process. Too often donor provided wells are not maintained or parts
are not replaced and subsequently the nearest water source is under utilised.

Villagers practice poor sanitation and hygiene.

Indigenous highland communities have habitual health and hygiene practices, including defecation
habits, infrequent hand washing, and limited knowledge, all of which serve to increase the incidence of
diarrhoea. In a baseline survey conducted in February 2004, 74% of the participants reported a family
occurrence of diarrhoea during the previous 2-week period. Among the survey participants (n=183),
67% knew at least one key health message about preventing diarrhoea. Washing hands before meals
and after using the toilet was mentioned more often than washing vegetables and drinking boiled
water. Villagers traditionally use the forest as their toilet and children and animals defecate near or
under the houses. Traditional beliefs enable the continued use of pigs to sanitize the village area.
Thus, few, if any, villagers have a household latrine. According to the 2005 government survey
(SEILA) there are only 500 toilets in the whole province, and only 6% of households have access to a
toilet.

Distance and time travelled to traditional water sources increases women's burden of work.
1
The Water and Sanitation Needs Assessment, Richard Tracey, Andrew Oliver-Smith, ZOA Refugee Care (ZOA), funded by
ECHO
Along with other daily chores, fetching water and collecting firewood are role expectations of
indigenous women and girls. Distance and the rough terrain, worse in the rainy season, increase the
time required to fetch portable water from the usual sources. Women and girls on average make 3 to
5 trips per day carrying a total of 50 to 70 litres of water. According to the 2005 government survey
(SEILA) less than 25% of households have an improved water source within 150 metres of their
house. Many water sources are located one Km or more from the house.

Women, who are the primary water collectors, have not been involved in village decision-making
process.
Women's role and women's work constrain their involvement in village decision-making. Limited
education and illiteracy further compound the problem. While village meetings may be conducted in
their native indigenous language, too often outside consultants and planners use Khmer as the
language of negotiation.

Involving women in community participation

Water supply projects bypass the women and girl end users at every stage; in problem identification
and needs assessment & analysis; in decision-making; in implementation; and in design, operation
and maintenance.
Recommendations suggest that future interventions must value and promote indigenous women's
knowledge of natural resources including water sources and supply and acknowledge their traditional
cleaning and maintenance activities2.

Results/ Expected Benefits

Output 1
A functioning system of repair and maintenance of water facilities in place that will enhance water
supply skills at community and central level and ensure water points work

Output 2
A constructive dialogue with communities takes place leading to improved hygiene and sanitation
practices in target communities

(the process needs to ensure ownership, understanding of traditional practices, and interaction with
maternal health project – TBAs)

Output 3
Water facilities in areas of acute need are built and repaired and integrated in to a sustainable system
of maintenance

Output 4
Schools in target areas are equipped with adequate sanitation facilities and teachers and students are
able to maintain the new facilities

Activities

Activities for Output 1

• Training Provincial Rural Development Department on maintenance and repair and
maintenance system
• Establish and support Water User Groups in each target village
• Ensure secure storage for spares – PRD or independent supplier
• HU and PRD to jointly manage the spares stock
• Create provincial level database with village level water and sanitation information that links to
the national database
• Regular water point testing (community training for skills transfer)
• Design complaint mechanism – village to central level. Initially information will come to HU,
after 18 months to PRD and HU
• Payment of spares – communities to pay 50% cost of spares. WUG will pay monthly/ yearly
and this money will go towards repairs

Activities for Output 2

2
Ibid and Water Supply and Sanitation Needs Assessment, Tracey, R. & et al.
 • Baseline survey (to understand people’s beliefs regarding disease transmission)
• Consultations with men, women and children (in indigenous languages) on habits of
defecation, urination, and hygiene. And the beliefs surrounding them
• Identification of habits that people are dissatisfied with and why
• Synthesize alternative behaviour that is better, easier, more hygienic and preferable for both
us and the community
• Possibility of latrine contruction (or facilitation of Community Led Total Sanitation
methodology) if this is what the community agrees to
• PHAST training for community facilitators

Activities for Output 3

• Survey of target villages to identify current condition of water sources, jointly with PRD
• Use survey to identify areas of greatest need within target 29 villages
• Community consultation for selection of appropriate water intervention
• Implementation of community approved and appropriate technology
• Training for Water User Group
• Ensure that new water points are incorporated in to maintenance system

Activities for Output 4

• Survey for hygiene knowledge of students and teachers
• Hygiene training for teachers and students
• Survey of sanitation facilities in 8 schools
• Construction of latrines for schools that don’t have latrines
• Water Filters installed in each school
• Student teams formed to maintain and clean toilets

Duration

3 YEARS

Sustainability

Technical
The project will recommend one of two handpump options, the Afridev or the VN6. It is also likely that
the project will dig boreholes, as opposed to hand dug wells, because boreholes are deeper and offer
a year round supply of water.

A key and innovative part of this project will be the support given to a spares and maintenance
programme. This will include a spares store, a database of water points and the problems that have
occurred. The project will train PRD staff to manage the spares supply by the end of the project.

Financial
The project will begin by expecting villagers to provide 50% of the funding for spares and maintenance
through a spares/ maintenance fund and this will increase to 100% by the end of the three year
project.
Annual fees for the installed systems will be collected and managed by the Water User Groups.
The project will also work on building the capacity of the Provincial Rural Development Department so
that they have the skills to support village level maintenance and are able to advocate for an increased
budget from the Ministry of Rural Development.

Institutional
As with previous water projects, Health Unlimited will continue to support the Ministry of Rural
Development’s model of Water User Groups. Ongoing training for the Water User Groups will be
provided and, crucially, the project will focus on building the capacity of Provincial Rural Development
staff so that they are able to continue to support Water User Groups after the end of the project.
Training will be enhanced by the use and distribution of the new Water User Group manual.
Social
Community participation and community ownership are key to the sustainability of rural water supply
and sanitation projects and an effort will be made at community level and in supporting training and
field experience for PDRD personnel to ensure local ownership.
Additionally, as women are the primary water collectors, they will be involved in the design, planning,
and implementation of the project interventions.
Men and women will gain the skills necessary to maintain water points and will have a sustainable
supply system in place for parts.

Environmental
Because of the large distances between the villages and small demand, the impact will be limited.