Final Report: Cambodia Assessment Affordable Sanitation in Challenging Areas in Cambodia and Lao PDR, Phase 1

Transcription

1 Final Report: Cambodia Assessment Affordable Sanitation in Challenging Areas in Cambodia and Lao PDR, Phase 1 Identifying Challenging Areas, Affected People and Local Sanitation Solutions April 2011 World Bank Water and Sanitation Program Report prepared by: Aruna Technology Ltd, #417 Preah Sisowath Blvd., Sangkat Chaktomuk, Phnom Penh, Kingdom of Cambodia info.aruna@arunatechnology.com Tel Fax web Community and Environmental Services Ltd. P.O. Box 7008, Vientiane Lao PDR atbott@yahoo.com Tel Fax

2 Table of Contents1... Introduction Background Objective of the Phase 1 study Scope and methodology Estimating affected populations Severity of impact of challenging areas Cambodia Country Context Demography and socio-economics Climate and topography Water resources Access to safe water and improved sanitation Activities and agencies in the Cambodian WATSAN sector General Institutional setup Ministry of Rural Development (MRD) ADB Tonle Sap Water Supply and Sanitation Project Lien Aid Live and Learn Organization, Engineers Without Borders (Australia), and ibop Asia International Development Enterprises (IDE) Cambodia ADRA (Adventist Development Relief Agency) AusAID Rural Sanitation and Hygiene Improvement Project World Bank North-East Village Development Project (NVDP) PLAN Community-Led Total Sanitation Pilot Project UNICEF Community-Led Total Sanitation Project Other agencies Existing Sanitation Solutions Latrine models and model development in Cambodia Ministry of Rural Development (MRD) Live and Learn Identification, Selection and Survey of Challenging Areas Criteria for challenging areas Selection of provinces and districts Lake floodplain: the Tonle Sap Settlement characteristics (floating villages) Settlement characteristics (lake floodplain and riverbank villages) Affected population Sanitation facilities and practices Study Area: Baribou District River floodplain (Lower Mekong River) Settlement characteristics Affected Population Sanitation facilities and practices Study Area: Kamchay Mear District Affected population Rivers and Riverbanks (major river systems and tributaries) Settlement characteristics Page ii

3 4.5.2 Sanitation facilities and practices High groundwater areas and swamps (lowlands and floodplains) Settlement characteristics Affected population Sanitation facilities and practices Study area: Basedth District Coastal areas Settlement characteristics Sanitation facilities and practices Affected population [Map 11: Coastal Topography and Villages] Summary of Key Findings Conclusions and recommendations Recommendations for Phase Annex 1: Lake Floodplain Tonle Sap: Socio-Economic and WATSAN Data Annex 2: River Floodplain Lower Mekong River: Socio-Economic and WATSAN Data Annex 3: Rivers and Riverbanks Major Rivers and Tributaries: Socio-Economic and WATSAN Data Annex 4: High Groundwater and Drought-Prone Areas, Old Alluvial Lowlands: Socio-Economic / WATSAN Data Annex 5: Coastal Areas Annex 5: Survey Instrument Annex 6: Challenging Areas Village Survey Data & Maps Tonle Sap Floating and Floodplain Villages Baribou District, Kampong Chhnang Province a) Village Information Lower Mekong River Floodplain Kamchay Mear District, Prey Veng Province a) Maps b) Tables Lowland Old Alluvium with High Groundwater Table and Drought Basedth District, Kampong Speu Province 107 a) Maps a) Tables a) Village Information Page iii

4 List of Maps [Map 1: Cambodia Provinces, Districts, Roads and Rivers]... 7 [Map 2: Cambodia Population Density]... 8 [Map 3: Cambodia Topography and Study Zones]... 9 [Map 4: Cambodia Topography and Flooding Depth-Duration and Extent] Map 5: Well Arsenic Concentration by Commune and Per Tested Well ( ).. 15 [Map 6: Mekong River Basin] [Map7: Tonle Sap Floodplain and Floating Villages] [Map 9: River and Riverbank Villages] [Map 10: Potential High Groundwater Village Locations] Map 12: Selected Study Villages, Baribou District, Kampong Chhnang Province Map 13: Selected Study Villages, Kamchay Mear District, Prey Veng Province Map 14: Selected Study Villages, Basedth District, Kampong Speu Province List of Tables Table 1: Results of National Survey of Access to Latrines and Drinking Water, Table 2: Total Population Living in Each Identified Challenging Area by Province Table 3: Tonle Sap Lake and Floodplain Villages Estimated Population Living in Area Table 4: Tonle Sap Lake and Floodplain Villages Modeled Severity of Affected Population Table 5: Lower Mekong River Floodplain Villages Modeled Estimated Affected Population Table 6: River and Riverbank Villages Outside Floodplains Modeled Estimated Affected Population Table 7: High Groundwater Villages Modeled Estimated Affected Population Page iv

5 Acknowledgments The team wish to acknowledge the invaluable support of the staff of the Ministry of Rural Development (MRD) at national, provincial and district levels, who provided essential support to the field team throughout the study. Abbreviations ADRA Adventist Development Relief Agency CLTS Community-led Total Sanitation DRHC Department of Rural Health Care DFID Department for International Development IDE International Development Enterprises KAP Knowledge, Attitudes and Practices MIME Ministry of Industry, Mines and Energy MPWT Ministry of Public Works and Transport MRC Mekong River Commission MRD Ministry of Rural Development NVDP North-east Village Development Project PDR People s Democratic Republic PPWSA Phnom Penh Water Supply Authority RGC Royal Government of Cambodia UDD Urine Diversion Dehydrating UNICEF United Nations Children s Fund USAID United States Agency for International Development WATSAN Water and sanitation WSP Water and Sanitation Program Page v

6 1 Introduction 1.1 Background Approximately 183 million people in Southeast Asia do not have access to improved household sanitation, the lowest levels of access being in Cambodia and Lao PDR 1. Both countries are committed the Millennium Development Goals, and in Cambodia the government has set a target of 30% access to improved sanitation in rural areas by 2015, and 74% in urban areas. At present, access stands at just 23.2% in rural areas while in urban areas it has already reached 81.5%. Factors contributing to low access in rural areas include: low incomes: Gross National Income stands at US $447 per capita, and 30.1% of the population lives below the poverty line 2 ; limited choice, and awareness of, low cost sanitation options; adverse geological, geographical and climatic conditions in many parts of the country, hampering the use of conventional sanitation technologies; and weak supply chains for sanitation hardware. This study was undertaken to assist the Government of Cambodia in developing affordable and appropriate sanitation options for communities living in challenging areas, in other words marginal land where conventional sanitation technologies cannot generally be used. For the purposes of this country study, challenging areas are interpreted as locations subject to one or more of the following conditions: high ground water levels; plains which flood on a predictable and seasonal basis; houses built on the banks of, or above, rivers and coastlines; houses built on stilts on river banks and moved as the water level rises or falls; riverine communities floating permanently on bamboo poles or simple boats; and sandy unstable soils along beaches and estuaries. Neither conventional nor most known alternative sanitation options are feasible at affordable prices for poor communities in such locations. The most common technical challenge is the lack of solid, dry ground for the disposal of excreta in pits or septic tanks, or for the laying of pipes and drainage. In some locations pits, pipes and tanks are feasible, but periodic flooding undermines both the superand sub-structure of toilets, resulting in extensive pollution and wasted investments. To enable greater access to improved sanitation in such areas, acceptable and affordable technical options need to be identified. This study is the first part of a regional project that seeks to address the challenge though a two-step process: Phase 1: Identify which challenging conditions prevail in which areas of the selected countries, the population affected, and the local sanitation solutions adopted by households. Phase 2: If necessary (i.e. in the absence of any suitable local solutions), develop and test appropriate and affordable sanitation options for the areas identified. This report is part of the output from Phase 1. The study used data from existing government and development agency sources to identify the principal challenging areas in Cambodia, estimate the 1 Economic Impacts of Sanitation in Southeast Asia, WSP, Poverty Profile and Trends, 2007: Findings from the Cambodian Socio-Economic Survey (CSES), June 2009, World Bank Poverty Reduction and Economic Management Sector Unit, East Asia and Pacific Region.

7 scale of the problem and, based on this, select sample locations for field data collection. Site selection was done in co-ordination with the Ministry of Rural Development (MRD), which has led responsibility for rural sanitation. 1.2 Objective of the Phase 1 study The objective of Phase 1 was to assist the Government of Cambodia - in particular the ministries responsible for rural sanitation in those countries - in understanding and addressing the need for improved sanitation in challenging areas. Figure 1: Women s Small Group Discussions, Serey Village, Khon Rang Commune, Baribour District, Kampong Chhnang 1.3 Scope and methodology In Cambodia, challenging areas for sanitation are primarily locations subject to flooding and/or having high groundwater tables, though there is in addition a significant, but smaller, population living on water. It was anticipated that, in these locations, there might be development agencies already working to develop appropriate sanitation technology options, or that indigenous solutions might also be encountered that could provide a starting point for further work in Phase 2. The study methodology was as follows: 1. Desk study to understand the regional and local situation regarding water and sanitation, and the overall impacts that poor sanitation is causing in these locations. To gain ideas for potential appropriate models for the areas that have been developed or found elsewhere and that might be put forward as potential ideas for discussion with the communities selected for the survey. To identify the different players and government agencies involved in water and sanitation in the country. To prepare draft survey forms and data collection tools. To undertake mapping to identify the most likely target areas for fieldwork. And to consult with stakeholders to finalize the selection of districts for fieldwork. 2. Field survey to examine sanitary facilities and conditions in typical villages in challenging areas. To include discussions with commune, district and provincial authorities to gain their perspective on current problems and learn about any relevant work undertaken to date. To undertake Knowledge-Attitude-Practice (KAP) surveys with stratified village groups Page 2

8 representing different income levels and with specific gender and vulnerable groups. To collect photos and GPS location data to allow documentation and discussion of these issues with higher level authorities and sector groups. The survey covered 22 villages in three districts in the provinces of Kampong Chhnang, Prey Veng and Kampong Speu. 3. Reporting to summarize and document the findings, including databases/geo-databases, maps and an estimate of the total affected population, and to make recommendations for structuring Phase Consultations, workshops and meetings to gain understanding of relevant work in the sector, both previous and ongoing, and to present the findings to provincial, national and international stakeholders and gain additional feedback for incorporation into the final report and Phase 2. The methodology was followed in general, but with some changes from the original plan. First, due to personnel and scheduling problems, much of the consultation work with sector agencies took place after the fieldwork and analysis, not before as was originally intended. Secondly, the planned consultative workshop was replaced by individual consultations with organizations to enable detailed and accurate information gathering Estimating affected populations The affected population in challenging areas was estimated as follows: Riverbanks: GIS software was used to identify the major rivers in the country as classified by the Geography Department. A notional 100m buffer was then defined alongside each river centerline and any villages located within it were counted as riverine and included in the affected population. A larger, 250m buffer was later used to conduct a sensitivity analysis. Surprisingly, this increased the affected population by only 60%. Floodplains: Data from the Mekong River Commission (MRC) were used to identify areas affected by different flood levels. These flood levels were determined from a combination of satellite imagery and hydrologic modeling and it became clear that flooding in Cambodia is highly localized and complex, arising from heavy rainfall and large volumes of water that are drained through very flat country with a lot of natural and man-made drainage courses. In the first round of analysis, an estimated 670,000 were found to be affected within the Tonle Sap floodplain and 1.5 million in the Lower Mekong River Floodplain. A second analysis expanded the affected area to take into account many villages which were on higher ground but were in effect islands surrounded completely by floodwater. This doubled the affected population for Tonle Sap and almost tripled it for the Lower Mekong Floodplain, though many of those added would be subject to less severe impacts than those counted in the first round. High groundwater: No data were available to enable the clear identification of high groundwater areas. Instead, approximate methods were used to give a rough indication of the general location and potential scale of these challenging areas. The WellMap groundwater database of hand-dug shallow wells and drilled wells was used to identify locations where wells with depth of less than 10m were located. A 250m buffer was placed around these locations using GIS software, and any village centre points located within these buffer areas were used as an indicator that the areas could be prone to high groundwater. This very approximate method gave credible results, identifying the Lower Mekong River floodplain as the primary area where high groundwater occurs, which confirms the findings of previous studies in Cambodia. That these areas also exist outside of the floodplains is known Page 3

9 anecdotally and was confirmed in the fieldwork in Kampong Speu Province. This said, the estimate is likely to be on the low side since the groundwater database does have complete information on well coverage in Cambodia. Floating and coastal villages: There were no specific identifying fields or codes within census or GIS databases that would allow explicit identification of these communities. Instead, manual identification was undertaken using the scanned topographic maps as the basis for understanding the village location. For floating villages, settlements that were in well-defined locations with roads were considered as floodplain rather than floating villages, so that only those villages located within the flooded area for long periods of time and who probably engage in fisheries as their main occupation were selected. This included some villages with permanent housing, usually located on riverbanks. Such villages were likely to include a mixture of households living on the water and on land, with some alternating between the two. In all cases, these villagers would spend significant time on the water where sanitary disposal of waste would be a problem. For coastal villages, a similar manual analysis was undertaken, with close proximity to the sea or inland estuaries, and a lack of permanent roads, being key factors Severity of impact of challenging areas The study found large variations in the impact of challenging environments. Not unexpectedly, there are many more people living on the edges of the floodplain, but above the normal flood zone, than there are within the floodplain. However, these people are affected on a semi-regular basis and with climate change could soon become more severely impacted. Short-term flooding can damage latrines and render them unusable during inundation periods, hence these locations were also of interest to the study. In order to provide a better understanding of the affected population, an attempt was made to model the distribution of severity among the population. This was based on a number of factors, including the geo-physical situation and conditions (living on water, or in areas that annually are completely flooded), the general settlement patterns and the experience of the Consultant in working in all of these areas over many years. Four categories of affected people were defined: (1) Severely affected: people dealing with challenging area problems every day or for months at a time; (2) Medium affected: people dealing with the problems for weeks at a time every year, or once every 2-3 years plus annual flooding ; (3) Moderately affected: people dealing with challenging area problems for short time periods of a week or less annually, or affected once every 5-10 years by large flood or rainfall events; and (4) Unaffected: people who are out of the flood locally or have otherwise resolved sanitation issues. This model is entirely subjective, but is useful for illustrative purposes to help explain the numbers. In summary, this study has undertaken a quite comprehensive analysis of the likely affected populations using the wealth of high quality data available, particularly from the 2008 census. The results appear to be broadly in line with the findings of the field survey and with the knowledge and experience of the researchers, who have been working in the area for a long time. The results are, nevertheless, indicative only, and many people are only affected during major floods that happen once a year or less frequently. Page 4

10 Challenging Areas Severely Medium Moderately Unaffected Affected Affected Affected Lower Mekong River Floodplain 40% 20% 20% 20% (Conservative Case) Lower Mekong River Floodplain 20% 40% 20% 20% (High Flood Case) Tonle Sap Lake and Floodplain 50% 25% 15% 10% (Conservative Case) Tonle Sap Lake and Floodplain 25% 50% 15% 10% (High Flood Case) Riverbanks Outside Floodplains 10% 40% 25% 25% Coastal/High Groundwater 25% 25% 25% 25% The analysis revealed that roughly 6 to 6.8 million people in Cambodia live in the defined challenging areas, some 43 to 49% of the population. Of these, the possible distribution of impacts is along the lines of: severely affected 1.7 million; medium affected 2.2 million; and moderately affected 1.4 million. The remainders are probably unaffected. Page 5

11 2 Cambodia Country Context 2.1 Demography and socio-economics Cambodia has total population of approximately 13.4 Million of which 80.5% are classified as rural population and the remaining 19.5% urban. 3 Annual population growth is 1.54%. The population under five accounts for 12.3 % of the total and the under-five mortality rate is 83 per 1,000 populations - second highest in Southeast Asia after Lao PDR. The percentage of the population below the poverty line is 30.1%, also the highest in the region 4. Most rural Cambodians depend on natural resources with agriculture, fisheries, gathering of other aquatic resources and a range of forest products providing the basis of their livelihoods. More than 8.5 million Cambodians have agriculture as their primary livelihood and more than one million earn their living from inland fisheries. Average rural household size is 4.6 persons, slightly smaller than the urban figure of 4.9. The most densely populated area is Phnom Penh and its environs, extending southwards to the Vietnam border in Kandal and Takeo Provinces. Other more densely populated districts are clustered around the towns of Battambang, Banteay Meanchey, Siem Reap and Kampong Cham. These comprise parts of the Tonle Sap Floodplain area and the Lower Mekong Floodplain primarily. The further one gets from the lowlands and floodplain, the less dense the population, which demonstrates that flooding is both beneficial and problematic, since many of the best soils, rice production areas and fisheries are within the floodplain. 3 Census 2008 data. 4 World Bank, 2009 Page 6

12 [Map 1: Cambodia Provinces, Districts, Roads and Rivers]

13 [Map 2: Cambodia Population Density] Page 8

14 [Map 3: Cambodia Topography and Study Zones] Page 9

15 2.2 Climate and topography The country has a moist tropical climate, featuring warm to hot temperatures throughout the year and an annual monsoon cycle of alternating wet and dry seasons of relatively equal length. The wet season occurs between May and October, while the dry season goes from November to March. Total annual rainfall is from 1,000 to 1,500 mm over most of the country, but there is considerable variation from year to year, resulting sometimes in severe flooding and sometimes in drought. Rainfall is also highly localized and can vary significantly between neighbouring villages. The heaviest rainfall is in the mountains along the coast in the southwest, where it ranges from 2,500 mm to more than 5,000 mm annually. Roughly three quarters of the country consists of the Tonle Sap Lake Basin and the Mekong Lowlands, the latter having the highest population density and agricultural production. Mountains and hills in the southwest, north and northeast of the country are forested and have low population density, some of the occupants being ethnic highland people. Cambodia's coast is contiguous with Thailand in the North and Vietnam in the South. These areas receive on average more than twice the rainfall of the rest of the country and contain more scattered pockets of population centered mostly around tourism, shipping and fisheries. The Upper Mekong Floodplain and Lowlands is a relatively small area as the topography is in transition from the highlands in Laos to the lower Mekong River. It consists of rolling terrain, much of it covered in open dry dipterocarp forest growing on poor thin soil that cannot support intensive or productive agriculture. The population in these areas is relatively small and there are only a few areas that flood, mostly small backswamp areas next to the Mekong or major tributaries. The Lower Mekong Floodplain and Lowlands area starts just downstream of Kampong Cham Town and contains roughly half the entire population. Population density here is 235 persons per square kilometer, the highest in the country. This area consists of 63 districts, 700 communes and 6,414 villages. The capital city of Phnom Penh, as well as Kandal, Kampong Cham, Svay Rieng, Prey Veng and Takeo provinces are located in this area. While primarily composed of ethnically Khmer people, the area also includes other ethnicities including Chinese, Vietnamese, Cham, Thai, Lao and Westerners. This area is very flat and experiences widespread flooding every wet season. On the periphery of the lowlands are plateau and foothill zones on old alluvium and mineral outcrops. As can be seen in the map on the following page, these areas experience annual flooding of different depth, duration and extent. The Lake Tonle Sap Floodplain and Lowlands area covers 67,668 square kilometers and contains just over 3.5 million - roughly 30 per cent of the total population. It consists of 60 districts, 488 communes and 4,041 villages. The area includes all or parts of Kampong Thom, Siem Reap, Banteay Meanchey, Battambang, Pursat, Preah Vihear, Kampong Chhnang and Oddar Meanchey provinces and Pailin city. The surrounding Tonle Sap area is inhabited by many ethnicities of people, including primarily Khmer, Chinese, Vietnamese and Cham. Figure 2: Floodplain Area, Kampong Our Village, Khon Rang Commune, Baribour District, Kampong Chhnang

16 [Map 4: Cambodia Topography and Flooding Depth-Duration and Extent]

17 The floating communities are predominantly Vietnamese. Surrounding the Tonle Sap Core Zone are the highlands to the West along the Thai border; these extend down to the coast. Cambodia's coastal area covers 17,237 square kilometers and has a population of 845,000. It includes Sihanoukville, Kampot and Koh Kong provinces and Kep city. All lie along the south and southwestern coast, which is 440 kilometers long. Sihanoukville is the mid-point of the coastal area and includes highlands that contribute orographic rainfall, a number of protected areas, mangrove and coastal lowlands, salt flats and lowland paddy. Most of the population live near the coast and experience problems with saline groundwater and flooding from the sea and inland Water resources The main water resources in Cambodia are surface and groundwater. Groundwater is used both for community and town water supply and for irrigation. Aquifer productivity is high in the eastern part of the country and low in the west. Groundwater levels are generally at their lowest from January to July, with maximum levels occurring from October to November. Most provinces use groundwater as the main source of domestic water supply. Figure 3: Shallow hand dug and tube wells in Trapeang Khyorng Village, Nitean District, Kampong Speu Surface water quality and quantity varies with the seasons. Flood waters inundate the floodplains surrounding the rivers and their tributaries and carry sediment levels hundreds of times higher than base flows. The Tonle Sap Lake provides a huge source of fresh water. During the late wet season the Mekong River backs up northwards into the lake increasing the volume of the lake tenfold, and the lake area by over seven times at the height of the flooding. As the flood abates, the flow reverses and the level of the lake drops. The surrounding area is protected freshwater flooded forest and marshland that forms part of the Tonle Sap World Heritage Site. However it is being increasingly converted into agricultural land with concomitant negative impacts on fisheries and water quality and expansion of temporary settlements into challenging areas. Surface water, mainly from the Mekong River supplies most of the eastern parts of the country, while the Tonle Sap and Bassac River system supplies the west and central parts of the country. Like other tropical countries, these surface waters are greatly affected by the seasonal conditions. 2.4 Access to safe water and improved sanitation Nearly half live of Cambodia s population live in the capital Phnom Penh while the remainders are distributed across 23 urban and peri-urban centers. These provincial centers generally have access to

18 unlimited surface water, but coverage of the piped water supply in the towns is as low as 15%, with service restricted to central areas. Rural areas utilize streams, lakes, and ponds, and groundwater resources from tube, pipe and dug wells. In most areas groundwater is available in large quantities throughout the year, although it is commonly high in iron content, as a result of which many people do not like to drink it. This has been a major challenge for some of the provincial water supply works. Rivers, streams and ponds are common sources of drinking water and of water for cooking. These water sources are often the same ones used for bathing, washing clothes, and disposing of waste products. Animals often access these water supplies further contaminating them. Some communities have to walk significant distances to gather safe drinking water during the peak of the dry season, work that tends to increase the labor burden for women. About 40% of dwellings Figure 4: Iron-Contaminated Water in Chhour Thnal Village, Cheak Commune, Prey Veng Province Page 13

19 receive water from dug wells. Nearly 29% go to local rivers and streams for their water supply. High rainfall also provides a reliable source drinking water during the wet season through collecting the rainwater in tank and jars. This runs out quickly during the dry season. In contrast, only around 7% of the population in Phnom Penh consumes water from a well; 81% is supplied through a piped water system and a further 10% is supplied by water trucks. The quality of the piped water has been tested to be of very good quality for a low cost. Figure 5: Better Quality Pour-Flush Toilet in Area of Good Water Supply, Cheung Khnar Village, Baribou District Large urban centers are partly served by combined sewage and storm drainage systems that consist of conventional flush toilets, sometimes draining into septic tanks. The majority of sewage systems have not been maintained over the past decades and were in a state of disrepair with 80 per cent of the pipes damaged. A recent Japanese-funded project has repaired a significant portion of the infrastructure and built additional drainage, however Phnom Penh continues to experience regular flooding during heavy rains. Sewage is not discharged to treatment systems, but directly to man-made canals then to waterways or water bodies, which are then used for drinking, bathing, swimming, and irrigation. While sanitation in large urban centers remains challenging, sanitation practices in rural Cambodia are much worse; proper disposal of solid waste and sewage is non-existent in most rural and suburban areas. Most communities in the rural areas see latrines are dirty (which they often are due to poor water supply and low maintenance) and prefer open defecation as it is perceived as being more natural. Canals, rivers and other water bodies are the place where rural communities discharge their waste. There is no solid waste management as well other than small-scale burning. The waste water and the solid waste management are negatively affecting the environment in urban and rural areas and serve as a means of disease transmission. Figure 6: Garbage Scattered on Slopes Draining Settlement, Trapeang Rumdenh Village, Nitean Commune, Basedth District, Kampong Speu Inadequate water supply and sanitation have been identified as a major contributor to the high diarrhea incidence in Cambodia. Many rural households lack basic sanitation facilities, and awareness of good hygiene practices is limited. Poor sanitation leads to economic losses estimated to be around US $448 million per year or US $32 per capita in lost productivity and health costs. This economic loss is equivalent to 7.2% of GDP 5. The 2005 Cambodia Demographic and Health Survey found that access to sanitary latrines was less than 30% in nearly all provinces. The Census 2008 data used for this study confirms that most rural households are still using unsafe means or defecate in the open. 5 Economic Impacts of Sanitation in Cambodia: A five-country study conducted in Cambodia, Indonesia, Lao PDR, the Philippines and Vietnam under the Economics of Sanitation Initiative (ESI). Research Report February 2008, EIC/World Bank WSP. Page 14

20 Map 5: Well Arsenic Concentration by Commune and Per Tested Well ( ) SCE Cambodia JC edits Jan11 with Annex.doc Page #15

21 Province % of Households not having sanitary latrines % of Households not having access to safe source of drinking water within 150 meter of the house 1 Battambang Banteay Meanchey Kandal Kampot Kampong Thom Kampong Cham Kampong Chhnang Kampong Speu Koh Kong Kratie Preah Vihear Phnom Penh Prey Veng Pursat Stung Treng Siem Reap Not available Not available 17 Sihanoukville Svay Rieng Takeo Table 1: Results of National Survey of Access to Latrines and Drinking Water, 2005 Open defecation is very common in rural areas, typically in places with tree or shrub cover, and often in paddy fields or areas near the house. Where there are toilets, the most common options are pits, either simple dug holes or holes reinforced with bamboo or concrete rings. There is a widespread preference for pour-flush latrines, but few rural households can afford these. During flood events, or when groundwater levels are high, often in combination with heavy rainfall, latrine pits get flooded, resulting in contamination of the floodwaters with human waste and spread of the excreta throughout the community. The latrines cannot be used during this time, so villagers revert to open defecation, which further contaminates the village environment. A MRD CLTS evaluation found that a similar proportion of simple CLTS latrines had been abandoned during the rainy season due to flooding or collapse. However, it also reported that most of the people who had abandoned their latrines were practicing dig and bury techniques during the rainy season and planned to return to latrine use once the rains were finished and they were able to clean and repair their latrines 6. A demand assessment commissioned by WSP 7 found that villagers are willing to invest different amounts to get a toilet, but the level of investment where more than half of them are willing to commit when asked is just $25. This is sufficient for a self-built low-cost improved pit latrine but not a pour-flush model. Affordability problems are exacerbated in places where flooding occurs regularly, people are living on the water or where groundwater levels are high. 2.5 Activities and agencies in the Cambodian WATSAN sector General The study researched and consulted with a number of players in the Cambodian WATSAN sector to gain information about their programs, activities and experience and to get their ideas about what might be done in the challenging areas. The agencies and persons met are listed in the Annexes. The 6 Community-Led Total Sanitation in Cambodia: Formative Evaluation Report, MRD, January Demand Assessment for Sanitary Latrines in Rural and Urban Areas of Cambodia, Roberts/Long, March2007 SCE Cambodia JC edits Jan11 with Annex.doc Page #16

22 study results have been reviewed and discussed at length with the World Bank WSP national and regional staff and consultants. Development partners such as donors, NGOs and other international institutions have been working together with government at national and/or local level developing and improving the sanitation situation through raising community awareness, education, mobilization, and funding construction of water points and latrines since A large number of different agencies are involved in the sector with WATSAN either playing a major role in their activities or being part of a range of investments within an integrated rural development project. The Cambodian WATSAN Sector Group has a monthly meeting hosted by the MRD to discuss various WATSAN issues that enjoys active and wide participation from a range of agencies including NGOs, UN organizations, bilateral and development aid staff, project staff and consultants. There is active sharing of experiences and information and cooperation on various initiatives to address common problems. This includes activities such as promoting handpump standardization, for instance. A number of projects and programs working in rural sanitation are outlined in the following sections Institutional setup A range of laws governing water and other natural resources have been promulgated or are under preparation. Institutional responsibilities for water supply and sanitation are distributed among four primary agencies. For Phnom Penh, there is the Phnom Penh Water Supply Authority (PPWSA) charged with responsibility for water treatment, and supply. The Ministry of Public Works and Transport (MPWT) is de facto responsible for urban drainage including sewage and sewerage due to the combined system. Solid waste collection in Phnom Penh and Sihanoukville has been contracted out to a private company called CINTRI, who are in negotiations to provide solid waste collection for two other large provincial towns. For smaller towns, responsibility for piped water supply is under the Ministry of Industry, Mines and Energy (MIME). For rural areas, the Ministry of Rural Development (MRD) is responsible for water supply and sanitation. Education for appropriate use of water and some aspects of sanitation is handled by PPWSA in the city of Phnom Penh and by Ministry of Health and MRD in the areas outside. The Ministry of Health has a broader role, covering water use, household and village hygiene, personal hygiene and food handling. MRD s Department of Rural Health Care plays a role in promotion of hygiene including three key messages: use a toilet, wash hands, and drink safe water. Budget and staff capacity problems limit the outreach and effectiveness of many of these campaigns. NGOs and development aid projects funded by bilateral aid and development banks provide support to several of the agencies at different levels and implement separate projects of their own funding with their own technical staff. These fill the gaps in government service and facility provision in many areas Ministry of Rural Development (MRD) The MRD is involved in many projects as a partner or co-operating agency, as well as running government-funded programs. In addition, they have developed a series of materials and manuals for different latrine designs ranging from low-cost do-it-yourself models that villagers can build for as little as $10 using local materials to the preferred high-cost pour-flush latrines with brick and mortar superstructures. The options include a high-cost design suitable for flooded areas; see Chapter ADB Tonle Sap Water Supply and Sanitation Project This project, started in 2005, has provided water supply and sanitation facilities to about 1,760 poorer villages in five provinces around the Tonle Sap basin (Battambang, Siem Reap, Kampong Chhnang, Pursat and Kampong Thom). The project built hygienic latrines for private households where beneficiaries selected from a broad spectrum of latrine types (pour-flush, sealed, ventilated improved Page 17

23 pit, and dry pit) whose standard designs, technical specifications, and estimated unit costs have been prepared by the project. Included in the scope of work are public latrines for schools, markets, health centers and other public buildings. The goal is to construct 150,000 latrines in the five provinces by 2011, and to reach 100% coverage in project villages by The total budget allocated for latrine construction is $6.15 million, while additional investments are being made in service contracts for community mobilization by NGOs and promotional materials for both water supply and sanitation. The project plans to provide $40 in subsidies per latrine while spending $5 per latrine on software activities. More than 75% of the sanitation subsidies of $5.6 million will be linked to the construction of expensive pour-flush latrines with households paying $40-$72 towards the cost. This will be difficult to manage for many if not all poor households given the finding of the WSP demand study 8 that the majority of rural households would not be willing to spend more than $ Lien Aid Lien Aid is a Singapore-based organization that has been implementing water and sanitation projects in Cambodia since mid It uses a market-based approach by motivating local people, creating a market demand and improving the supply chain and is currently working on four projects: 1. River of Life (Floating Villages) in Kampong Chhnang Province: promotion of urine diverting dehydration (UDD) latrines and water treatment plant. 2. Water SHED: Water, Sanitation and Hygiene Enterprise Development. Development of locally-owned communal water treatment enterprises with sustainable business models, along with affordable toilet options made available to low-income communities. 3. Hospital and Health Center WASH and WASH Marketing in Kampong Speu Province: water and sanitation in a referral hospital, health centre and rural villages. Lien Aid has also undertaken a number of other WASH projects including a Community-led Total Sanitation (CLTS) project in Kampong Speu, construction of WASH infrastructure and facilities, arsenic mitigation and a national sanitation campaign. It works closely with local communities, governments and NGOs to assess the needs of each area against their resources and expertise Live and Learn Organization, Engineers Without Borders (Australia), and ibop Asia From 2009 to 2010 the NGOs Live and Learn Cambodia, Engineers Without Borders (Australia) and ibop Asia worked in partnership to develop appropriate technologies for sanitation in the floating communities in Cambodia. Their project Affordable Sanitation for Floating Communities in Cambodia addresses all aspects of water supply and sanitation in Phat Sanday Commune, Kampong Svay District, Kampong Thom Province. This is discussed further Chapter International Development Enterprises (IDE) Cambodia IDE launched the Sanitation Marketing Pilot Project in Cambodia in October 2009, aiming to have over 10,000 toilets purchased and installed by households in rural villages over a period of 18 months. The project is funded by USAID Cambodia MSME and the World Bank Water and Sanitation Program (WSP) and is implemented by IDE Cambodia. 8 Demand Assessment for Sanitary Latrines in Rural and Urban Areas of Cambodia, Roberts/Long, 03/2007. Page 18

24 Rural households are encouraged to stop open defecation and invest their own resources in a sanitary latrine. The project includes the introduction of attractive and affordable latrine designs (developed with support from IDEO, a major US-based design firm); humorous and edgy village-level social marketing campaigns inspired by the CLTS approach; and strengthening of enterprises in the local latrine supply chain. After seven months of field work, more than 3,000 latrines have been purchased. The project has developed the Easy Latrine design, which provides a good quality and popular latrine at a cost of $35 in material; this recently won a prestigious design award. The practical approach used where difficult to make parts were pre-fabricated, costs were reduced by more careful engineering and adaptations made to use local materials are lessons learned that need to be applied to any sanitation design project. Figure 7: The Easy Latrine IDE have also successfully promoted ceramic water filters through their market-based approach and have established a production facility to make the filters in Cambodia. More than 140,000 filters have been distributed to date ADRA (Adventist Development Relief Agency) ADRA works with rural poor and at risk populations in Kampong Thom, Preah Vihear, Pursat and Siem Reap, as well as in Phnom Penh. They have longstanding water and sanitation programs in these provinces as described below: Rural Development Program - Siem Reap ( ): The WATSAN component supports the installation of wells and latrines along with household hygiene education. Kampong Thom Water and Sanitation Program (1993 to present): The program evolved over time, initially focusing on a relief-based response to immediate needs of the local population and internally displaced people. During this first phase, 260 family-group wells with local labor contributions were completed. The use of community water technicians trained by the program has resulted in over 3,600 ring wells in Kampong Thom being installed. Hygiene and sanitation training was provided at the water points and through the public school system. In 1999 the program diversified to include community requests for latrines, rain-water storage units and pumping devices. Over 2,600 durable pour-flush latrines, 800 water tanks and 1,100 treadle pumps have been installed in this period through community technicians. This entire program has been implemented in close collaboration with the Department of Hydrology (previously) and the Department of Water Resources and Meteorology (currently). The Women s WELL Project: Water-Empowerment-Learning-Livelihoods, Preah Vihear Province (2002 to Present): The WELL Project has been integrating three main aspects of rural development: water/ sanitation; economic development; and learning. ADRA s approach to water/sanitation builds directly on experience from Kampong Thom. Two volunteers were selected and trained in each Page 19

25 commune. These technicians are responsible for all technical aspects of well digging and installation, water tanks and latrine construction. While the water component initially had a slow start due to difficult digging conditions, it has shown exponential growth, (20 wells in the first year to 230 installed in the 2003 dry season) AusAID Rural Sanitation and Hygiene Improvement Project The Department of Rural Health Care (DRHC) implemented this AusAID-supported pilot project in Takeo Province from September 2005 until October The project promoted 400 household latrines in fourteen villages of two communes in Kirivong District. The project provided each household with a $25 latrine material package (three concrete rings, a latrine slab and a ceramic pourflush pan) and asked user households to pay the contractor $8.50 in cash towards additional materials (one concrete ring, 10kg cement and pipework). The user households were responsible for installing the below-ground components (rings, slab, pan and pipework) and for constructing their own latrine superstructure. While the project used a CLTS approach with the intention of ending open defecation communitywide, only 9% of the target population was reached with its subsidized latrines World Bank North-East Village Development Project (NVDP) The NVDP undertook a bottom-up participatory process in 120 target villages in Kampong Cham, Kampong Thom, Kratie and Stung Treng Provinces between 1999 and The project funded construction of 5,625 household latrines in an attempt to reach 100% coverage in the one third of the villages which had selected sanitation as a priority. A $100 latrine model was promoted by the project with beneficiaries required to pay $3 in cash and provide some labor even with this minimal contribution and a significant investment in software, getting villagers to provide this investment proved challenging. However, good quality latrines were built and were being used in these areas PLAN Community-Led Total Sanitation Pilot Project In , Plan International, in partnership with the DRHC, implemented a pilot Community-Led Total Sanitation (CLTS) project in four villages (two in Siem Reap Province and two in Kampong Cham Province). This small pilot project was a learning process for both Plan and DRHC. No subsidies were provided to households for sanitation hardware, hence all project costs related to training, participatory activities, field monitoring and program overheads UNICEF Community-Led Total Sanitation Project UNICEF has been the main agency supporting the sanitation sub-sector in Cambodia for some years, and has been the driving force behind the recent mainstreaming of the CLTS approach. UNICEF funded the initial CLTS training of trainers course in September 2005 and subsequently encouraged decentralized implementation through the Provincial Departments of Rural Development. Whilst this approach has encountered some difficulties, e.g. rigid rules of the Province Executive Committees preventing rapid implementation or changes in implementation plan, it has also resulted in significantly lower costs and a rapid scaling up of implementation 9. The project operates in six provinces and by the end of 2009 some 300 villages had been declared open defecation-free (some of them supported by other agencies) Other agencies Concern Worldwide, have been at the forefront of implementing CLTS projects in Cambodia along with UNICEF and Plan International. NGOs who are involved in sanitation include the International Federation of Red Cross and Red Crescent Societies, CWS-Cambodia and Muslim Aid Cambodia. 9 Robinson, Page 20

26 DFID, the British government aid agency supported implementation of the Rural Sanitation Cambodia project which provided basic water and sanitation facilities in a number of rural areas. Page 21

27 3 Existing Sanitation Solutions 3.1 Latrine models and model development in Cambodia There have been some initial, encouraging efforts towards the design and dissemination of affordable and appropriate sanitation models in Cambodia. These include a model specifically designed for areas which are flooded or subject to high groundwater tables Ministry of Rural Development (MRD) The MRD released the Informed Choice Manual on Rural Household Latrine Selection in 2008 and prepared an accompanying set of materials including flip charts of low-cost sanitation options (pit latrines with different potential options for lining the pit, platform, superstructure, etc.). This is a very useful effort that demonstrates the wide range of options that exist to construct acceptable toilets using primarily local materials at low cost, but also includes top end designs since these are clearly the most preferred at all socio-economic levels. It also provides information on two designs appropriate for challenging areas (shown below), one being a raised latrine for high groundwater areas and the other a flooded wet pit latrine design for flooded areas. Figure 8: MRD Informed Choice raised latrine design for high groundwater table areas (left) and example of a low-cost local solution from the field (right, from Robinson, 2007) The manual notes for the high groundwater latrine that: Any latrine can be adapted for use in an area with high ground water table. High groundwater levels are a problem because the solids in the pit form a layer of scum that floats on water. As the water table rises in the wet season, this scum comes out through the squatting hole (in a dry pit latrine) or through the tank cover (in a wet pit latrine). The basic solution to this problem is to raise the pit using the soil from the excavation. The minimum below ground depth depends on the amount of water used in the pit and the permeability of the soil. The raised portion of the pit can be surrounded by a mound of soil. Raised pits can be used in combination with any other type of pit latrine (VIP, pour flush double pit). Raised pits should normally be lined, and in general the construction will be more expensive than that of a latrine which does not need to be raised. The picture shows a latrine that is raised a lot. Depending on the local situation, the pit may need to be raised by a lot or a little. Steps can be made of bamboo, wood or concrete, depending on availability and costs. In the design and construction, pay attention to any users with special needs that use the latrine (elderly people, pregnant women, and disabled people). Small adaptations may be needed to allow them to use the latrine also (e.g. a banister next to the steps). Page 22

28 The MRD Flooded Wet Pit Latrine design is shown to the right. The manual notes that: Areas that flood during the rainy season need a special approach. A pit can still be constructed, but above ground, it should be connected to a slab and pan by a number of concrete rings and pipe. The number of concrete rings and the length of pipe will be changed according to level of water during the flood. Since the pit will fill completely during the flooding, the only usable area of the tank will be the part extending above flood level. The superstructure needs to be raised further above this, with a pipe connecting the squat above this. Although a dry latrine (i.e. an open hole) is possible, availability of water is not usually a problem in flooding areas, and water-based latrines are common. A flooded wet pit latrine is more expensive than other types of latrine, and building materials may be weakened from being submerged in water. Emptying a latrine like this is not straightforward, and consequences of bad workmanship (toppling, shifting rings) can be very unpleasant. Not to be constructed without specialist advice. Figure 9: MRD Informed Choice Flooding Wet Pit Latrine design for flooded areas. This flooded wet pit latrine provides a good starting point for dealing with challenging area situations although it also needs to be sealed and remains problematic in terms of maintenance. This type of latrine is also quite costly, and will not be affordable for the majority of the Cambodian people living in these areas. The large difference in flood levels experienced in some locations (above 7 meters) would make this design non-viable without major increases in costs and the need for structural integrity for the rings to support such a high pit. While the MRD has laid a foundation for the development and promotion of appropriate and affordable sanitation options there remains significant work to be done to make the designs affordable for the majority of poor and middle-income people living in rural areas Live and Learn The Live and Learn project was briefly described in Chapter 2. Their approach in terms of model design for the floating village household latrines and water treatment plants was as follows: 1. Developed a relationship with the Phat Sanday floating community in Cambodia. This has allowed Live and Learn to develop the community s idea of sanitation, use their input to help develop a culturally appropriate sanitation solution for the floating communities. 2. Conducted a comprehensive review of existing sanitation options used around the world in floating and land based situations. Selected Urine Diversion Desiccation (UDD) as the most appropriate for the floating communities. 3. Designed a basic floating latrine and developed a manufacturing technique using locally available materials. The current Material cost is US$35 and labour cost is US$5 per latrine. 4. Built and trialed 13 prototype floating latrines (11 in the Phat Sanday community) and regularly followed up their use. Each new prototype has incorporated improvements learnt from construction and use of earlier models. Page 23

29 5. Educated users of the floating latrine about the importance of total sanitation and how to use and maintain the latrine. Including classes at both Phat Sanday primary and secondary school. 6. Commenced construction and trial of a Community Floating Waste Treatment Barge that will demonstrate technologies and practices for human waste treatment. 7. Developed a human waste management cycle that will employ the floating toilet, the Floating Community Waste Management Station and floating garden beds to manage human waste in a manner that will provide an incentive for the community to take up improved sanitation by generating social, economic and environmental dividends for the floating communities. Figure 10: Installing a UDD latrine in the floating Village. Figure 11: The Floating Community Waste Management Station Page 24

30 4 Identification, Selection and Survey of Challenging Areas Initial selection of the specific areas for the study was based on a number of factors including the severity of the problem, the population affected and the geographical extent of the situation. The eventual selection was made in close consultation with the national authorities at the MRD in Cambodia and represents a compromise between the factors described above, logistics and areas which the partner agencies decided were particularly important. 4.1 Criteria for challenging areas All of the defined criteria for challenging areas exist in Cambodia, as summarized in the table below: Type of Area Locations in Cambodia Priority High groundwater levels Floodplains which flood on a predictable and seasonal basis Houses built on the banks of or above the water on rivers and coastline; Small houses placed on short stilts on river banks, and moved as the water level rises or falls; Riverine floating communities living in houses floating on bamboo poles or on simple boats all year round; Sandy unstable soils along beaches and estuaries. Numerous, however insufficient groundwater data available to identify locations or extent Mekong River and Tonle Sap floodplains; tributary floodplains Mekong, Tonle Sap and Bassac Rivers and all tributary streams; swamps and perennial ponds Tonle Sap Lake and floodplain Tonle Sap Lake Kep, Kampot, Preah Sihanouk, and Koh Kong Provinces along the coast Important due to likely high prevalence since exists in both floodplains, lowlands, coastal areas and uplands, but hard to study without data and location Very important since it affects a large population Important as it affects a large number of people, although the severity of the problems is not extreme Less significant as not so many people are affected Very important since it affects a significant proportion of people, who have limited options and considerable impacts Less important as it does not affect a large number of people Page 25

31 [Map 6: Mekong River Basin] Page 26

32 Any technology developed for use in challenging areas will likely have a wider use than in just the areas that were studied. The following areas were examined as part of the desk study to assist the process of selecting the eventual study areas: 1. Lake Floodplain: The Tonle Sap 2. River Floodplain: Lower Mekong River Floodplain 3. Rivers and Riverbanks: Major River Systems and Tributaries 4. High Groundwater Areas and Swamps: Lowlands and Floodplains 5. Coastal Areas and Estuaries The estimated population living in each of these identified challenging areas is shown in Table 2. These are total populations; those affected by the challenging conditions will be only a part of the total. 4.2 Selection of provinces and districts Three provinces with different hydro-geographical conditions were selected to provide a representative sample of the most important identified challenging areas. They were: Kampong Chhnang Province (Tonle Sap Floating Communities and Floodplains); Prey Veng (Mekong River Floodplains and Riverbanks); and Kampong Speu Province (High Groundwater Tables in Old Alluvial Lowlands). MRD proposed to include Kampong Speu, an area of rolling terrain in old sandy-silty alluvium, instead of the coastal zones, because it had a high water table, a problem which affected more people than the number living on the coast. After selection of the provinces, the survey team met with the Provincial and District Departments of Rural Development staff in the target provinces, and with local authorities at the Commune level. Discussions were held with all these government agencies about the objectives of the survey and potential locations. After consultation, the following provinces and districts were selected: Kampong Chhnang: Baribou District Prey Veng: Kamchay Mear District Kampong Speu: Basedth District 4.3 Lake floodplain: the Tonle Sap The Tonle Sap is the largest freshwater lake in Southeast Asia and about one million people live within the lake boundaries defined by the roads encircling it. Fisheries sustain the rapidly growing population of mainly poor rural inhabitants of the floodplains. The increasing demands on its land, water, and biotic resources are threatening the lake ecology Settlement characteristics (floating villages) Over 200 communities with a total population in excess of 80,000 live in floating villages around the lake and Tonle Sap River. Settlements consist of simple houses made of temporary materials such as bamboo and wood with irregular form. The housing is mostly low density except in village centres where there are only narrow gaps between the houses, which are accessible only for small boats. There are also single, scattered floating houses all over the lake. The floating houses use bamboo or wood as a platform and move all year round depending on the season and water level. In addition there are communities living on static house boats. Page 27

33 Province Table 2: Total Population Living in Each Identified Challenging Area by Province 10 Total Affec ted Villa ges (Villa ge) Total House holds (HH) Total Popul ation (Perso ns) Lower Mekon g Flood plain (% of Total) Tonle Sap Lake and Flood plain (% of Total) Riverb anks Outsid e Floodp lains (% of Total) Banteay Meanchey , , % 9.2% 364,9 Battambang , % 33.0% Kampong 199,69 891,4 Cham % 0.1% Kampong 223,8 Chhnang , % Kampong 27,45 Speu 51 5, % 74.0% Kampong 355,4 Thom , % 3.1% 158,5 Kampot , % 9.2% 235,97 1,150, Kandal % 0.8% 107,5 Koh Kong 95 22, % 185,5 Kratie , % Mondolkiri ,417 % 439,9 Phnom Penh , % 0.5% Preah Vihear 11 1,141 6,064 % 182,79 770,5 Prey Veng % 0.2% 217,8 Pursat , % 15.6% 26,71 Ratanakiri 60 4, % 292,5 Siem Reap , % 2.0% Krong Preah 46,58 Sihanouk 31 9, % 69, Stung Treng 89 13,313 1 % 286,2 Svay Rieng , % 0.5% Float ing Villa ges (% of Total ) 0.1 % 4.0 % 35.3 % 2.8 % 6.3 % 11.0 % Coa stal Area (% of Tota l) 30.0 % 44.2 % 89.1 % Takeo , , % Oddar Meanchey 11 1,798 8, % Krong Kep 9 3,533 17, % 37.3 High Gro und wate r (HG W) (% of Tota l) HGW plus Other Challen ging Area (% of Total) 17.5 % 13.4% 1.2 % 2.2% 2.6 % 0.4 % 2.0% 5.3 % 14.5% 0.8 % 1.7% 1.8 % 1.4% 0.5 % 5.1% 2.7 % 0.4% 2.0 % 10 Note that this is the total population in the villages within the areas. The estimate of the number of affected people will be a subset of this total population. Page 28

34 Pailin ,011 6,47 1,365, TOTAL % % 6,495, % 21.0% 6.7% 2.3 % 2.7 % 4.2 % 5.4% Page 29

35 Figure 12: Village Selection with Baribou District MRD Staff, Kampong Chhnang Province Figure 7:Floating Houses, Baribour District, Kampong Chhnang Settlement characteristics (lake floodplain and riverbank villages) Most communities build stilted houses along elevated roads or riverbanks. Houses at Kampong Pluk are up to 6 meters high, while they can be as high as 10 meters in the stilted houses at Kampong Khleang. During the dry season, the villagers move out to the Tonle Sap lake and build temporary stilted houses there, and in the wet season when the water level rises again, the villagers move back to their temporary or semi- permanent houses on the floodplain with the stilts under water, moving whatever they require with them in their boats. The communities in Kampong Khleang 11 next to the Tonle Sap are the largest settlements on the lake. As with all communities around the lake, the fishing community of Kampong Khleang undergoes continual changes due to the seasonal flood levels caused by the reverse flow of the Tonle Sap River. Figure 13: High Stilted house in Kampong Khleang Village, Kampong Chhnang Province 11 Photo taken from copyright Arto Teräs Page 30

36 4.3.3 Affected population While an estimated 80,000 people live in floating villages 12, a much larger number live on water for extended periods within the floodplain or on the edges. The severely affected are estimated to be around 500,000 persons while the medium-affected are at around 650,000. The total number of people affected to any degree is therefore estimated by the model to be around 1,350,000. For the Tonle Sap, we have weighted the severity as being highest in Cambodia since a significant number of people are living on the water throughout a large part of the year and the remainders are affected by the expansion of the Tonle Sap to its fringes Sanitation facilities and practices Floating Villages Most people living over the Tonle Sap lake defecate directly into the water. A typical latrine in a floating community (whether above a river or a lake) is an open hole on wooden planks from which excreta drops straight into the water. Some people may use a squatting pan with water seal, which again releases excreta directly into the water. The same lake and river water is used by the communities for drinking, cooking, bathing and other domestic purposes. The lake receives all domestic waste water and also solid waste. Floodplain and Riverbank/Road Villages The villages on the edge of the floodplain and permanent houses in the floodplain exhibit typical characteristics of rural Cambodian villages, with latrine coverage at roughly 25%. Better off Figure 14: Drop Hole Latrine in Floating Village Directly Discharging into Tonle Sap, Kampong Chhnang households (mostly in urban and peri-urban areas) have higher coverage as would be expected and mostly have pour-flush latrines, while other households with a facility have dry pit latrines. Toilets are generally offset from the house and are pour-flush for the better off families and pit latrines for others. All types have problems during flooding, when they cannot be used. The majority of the villagers still practice open defecation, as do those with latrines during flood periods. 12 The Tonle Sap Biosphere Reserve: The Heart of Cambodia, Tonle Sap Environmental Management Project (TSEMP), undated. This document notes there are 80,000 people in more than 200 floating villages. The GIS analysis following the methodology described above counted 151 potential floating villages with population of 149,000. For the Study, the GIS figures are retained as even those living in permanent houses in this area are essentially living in floating houses that are anchored to the ground during several months of the flood season. Page 31

37 Province Table 3: Tonle Sap Lake and Floodplain Villages Estimated Population Living in Area Total Villag es (Villa ge) Total Househ olds (HH) Total Popula tion (Perso ns) Tonle Sap Lake and Floodp lain Tonle Sap Lake and Floodp lain (%) (HHs) Tonle Sap Lake and Floodp lain (Perso ns) Floati ng Villag es (% of Total ) Floati ng Villag es (HH) Floati ng Villag es (Perso ns) Banteay Meanchey , , % 49, , % Battambang , , % 47, , % 2,610 14,681 Kampong Chhnang , , % 29, , % 15, ,949 Kampong Thom , , % 70, , % 1,844 9,811 Pursat , , % 33, , % 2,546 13,648 Siem Reap , , % 51, , % 6,155 32,105 Oddar Meanchey 11 1,798 8, % 1,791 8, % 0 0 TOTAL 1, ,756 1,513, % 284,01 3 1,363, % 28, ,54 9 Table 4: Tonle Sap Lake and Floodplain Villages Modeled Severity of Affected Population Province Total Villages Total Households Total Population Severely Affected Medium Affected Moderately Affected Unaffe (Village) (HH) (Persons) (Persons) (Persons) (Persons) (Perso Banteay Meanchey , ,213 75, ,713 33,210 23,7 Battambang , ,609 77, ,916 34,245 24,4 Kampong Chhnang , ,236 70,353 95,795 30,973 22,1 Kampong Thom , , , ,578 48,039 34,3 Pursat , ,479 54,530 74,250 24,007 17,1 Siem Reap , ,855 91, ,208 40,160 28,6 Oddar Meanchey 11 1,798 8,515 2,708 3,687 1, TOTAL 1, ,756 1,513, , , , ,3 Page 32

38 Most people defecate in the forest in the dry season, and around the house in the wet season. Some bury feces near the house, while others allow their animals (pigs, dogs, chickens and ducks) to eat them. If there is water, that is used for anal cleansing, while leaves are usually used if not. People indicated that hand washing varied from 20% to 90% but it generally appeared to be done by most people. Most women use menstrual pads which are buried after use. The remainders use multiple layers of clothing or cloths which they wash afterwards. Figure 15: Latrines differ according to economic status, Cheung Khnar and Toul Thlork Villages, Baribour District, Kampong Chhnang The field work confirmed that access to a safe and reliable water supply options is very limited in these communities. Most people use surface water or other unprotected sources. Furthermore, water supply is often far from riverbank villages in the dry season, an issue affecting over a third of the floodplain residents. Figure 16: Svay Koy Floating Village, Baribour District, Kampong Chhnang Page 33

39 [Map7: Tonle Sap Floodplain and Floating Villages] Page 34

40 4.3.5 Study Area: Baribou District The target villages in this district are representative of general conditions on and surrounding the Tonle Sap Lake and along the Tonle Sap River floodplain. The survey was conducted in six target villages within 3 communes: Punley Commune: 2 villages (Svay Koy and Chheung Khnar); Khon Rang Commune: 2 Villages (Kampong Our and Serey); and Melum Commune: 2 Villages (Melum and Toul Thlork). Villages located in the seasonal flooding area have a generally acceptable water supply. Some have received assistance with water supply and sanitation from NGOs and district latrine coverage varies widely, from just 3% (in floating villages) to 73%, with an overall average of 40%. At one of the villages visited, Kampong Our, the community were not concerned about existing sanitary facilities; defecation into the water was an established practice and they were more concerned about the risks of drinking untreated water. Turbidity is a particular concern as it is high for much of the year. Some families boil water before drinking, and some use the flocculent alum to reduce the turbidity of water before cooking with it, while others drink raw water. The community made a strong request for a floating water treatment system similar to one in a neighboring village. They were willing to pay a reasonable fee for water from such a supply. Average toilet coverage in the six villages was 39.5% - in line with the Baribou district average of 40%. Many of the toilets are not used during the wet season when pits fill with water and are become difficult to flush. Nearly all respondents agreed that poor sanitation leads to poor health; however a lower number said that sanitation was a high priority for them; most respondents said that water supply was much more important than having a latrine, and in some villages basic food and shelter issues took priority over even water supply. The simple conclusion is that community buy-in to sanitation programs will be much greater if preceded or accompanied by water supply improvements. Respondents reported that hand washing after defecation ranged from 78% (rich/middle groups) through 58% (average of poor groups), down to 48% for women s groups. Hand washing practices were better than those reported in the other two provinces surveyed, which may be due to the higher percentage of better off households, most of them with toilets, in Baribou District. Figure 17: Latrine Overhanging Tonle Sap Lake, Kampong Our Village, Baribou District, Kampong Chhnang Page 35

41 4.4 River floodplain (Lower Mekong River) Cambodia is prone to natural disasters, primarily floods and drought, which can have a serious impact. At the same time, the livelihoods of a large portion of the rural population are dependent on the annual flood. The flood-prone areas are the Mekong Plain running through the center of the country downstream of Kratie including the surrounding Tonle Sap Lake, Lower Mekong River Floodplain and its tributaries. In addition, there is an area covering much of southern Svay Rieng Province where floods predominate in the wet season. This is partly caused by the Vaico River which drains the area, 13 but mostly comes from floods backing up from the Mekong River into Cambodia as a result of drainage channels and flood prevention dykes constructed along the Vietnam border. Figure 18:Medium to Good Quality Housing, Tboung Wat Village, Krabau Commune, Prey Veng The map on the following page shows the location of the most flood-prone areas in Cambodia. When the river reaches its highest peak, local rainfall also intensifies (second peak in September) adding more water to the rivers and causing localized flooding and flash flooding Settlement characteristics The floods on the Tonle Sap were described in the previous section. Stronger floods, with more powerful flows and a similar spread over a wide area also occur in the rural areas and urban centers and towns in tributary and Lower Mekong River floodplain. The housing in urban centers and towns can be made from permanent or semi-permanent materials and settlement tends to follow a clear pattern along the roads in front of the houses. During high floods, roads in the plains are not accessible and villagers travel by boat. The backswamp areas behind the riverbank levees of the Mekong and Bassac habitually flood and remain flooded throughout the height of the rains. The release of water from the backswamp is controlled to allow fisheries and agriculture. The floodplains in the middle of the two major rivers get uncontrolled and swift flooding that strands villagers in their homes for extended periods every year. More than 60% of the population in the floodplain obtain their drinking water from wells and these can become damaged and/or contaminated during floods. Flooding also damages roads, houses and Figure 19: Women's Group Meeting, Cheung Khnar Village, Baribour District infrastructure including latrine pits, septic tanks (used in some of the urban areas) and small piped water supply systems. Recent investments in the urban and per-urban areas have, however, improved waste disposal and drainage, so reducing the impact of floods in these areas. 13 The Vaico River is not in the Mekong River catchment, however the floods from the Mekong River backflow into the area as a result of the artificial drainage channel and flood prevention dykes constructed by Vietnam in the Mekong Delta that redirect floodwaters into this area. Page 36

42 [Map 8: Lower Mekong River Floodplain Villages] Page 37

43 4.4.2 Affected Population The government policy for flood mitigation and protection is to accelerate flood mitigation programs in areas where flooding has had a serious impact on the social and economic development of the area. The RGC has identified flood (and drought) mitigation measures in the Eastern Part of the Mekong Delta as high priority actions including two provinces, Prey Veng and Svay Rieng. These, along with Takeo and Kandal Provinces encounter widespread flooding on an annual basis. As seen in the tables below, the numbers of people affected are approximately 4 million, or just under 30 percent of the country s total population. Of these, approximately 1,000,000 are modeled to be severely affected, and 2.1 million medium or moderately affected. Table 5: Lower Mekong River Floodplain Villages Modeled Estimated Affected Population Province Total Villages Total Households Total Population Severely Affected Medium Affected Moderately Affected Unaffected (Village) (HH) (Persons) (Persons) (Persons) (Persons) (Persons) Kampong Cham , , , , ,454 93,256 Kampong Speu 9 1,249 6,409 1,589 2,218 1, Kampot 96 21,878 96,399 23,907 33,354 18,701 12,243 Kandal ,495 1,080, , , , ,191 Kratie , ,263 34,041 47,493 26,629 17,432 Phnom Penh , ,893 98, ,325 76,997 50,405 Prey Veng , , , , ,444 97,177 Svay Rieng , ,921 70,660 98,583 55,275 36,185 Takeo , , , , ,142 74,067 Krong Kep 6 2,226 11,168 2,770 3,864 2,167 1,418 TOTAL 3, ,759 4,095,973 1,015,801 1,417, , , Sanitation facilities and practices Settlements on the edge of the floodplain are typical Cambodian villages, being strung out along roadsides and riverbank levees, as nearly all other areas are underwater for long periods in the wet season. Census data reports low latrine coverage; improved facilities are again concentrated in the urban and periurban areas amongst the better-off people. Low coverage was confirmed by the field work: the majority still practice open defecation, and only 3 respondents out of 89 in the focus group discussions had latrines. All had problems during the floods, when the latrines could not be used. Figure 20: Good Quality Latrine, Village, Krabau Commune, Prey Veng Villagers tend to defecate in the forest or near their house. After defecating near the house, most people bury the faeces, though some reported that they let the rain wash it away. Children tend to defecate all around the house. Anal cleansing is usually done with earth or leaves for adults, although water is preferred if available, and with water for children when near the house. No soap is used. Hand washing is reported to be done by most villagers. For women, menstrual pads are commonly used in some places, extra cloth and underwear in others. These are either buried (pads) or washed (cloths and underwear). Page 38

44 Water supply in the Lower Mekong River Floodplain villages is generally better than in the Tonle Sap region. However, almost 40% still have a poor source of drinking and domestic water Study Area: Kamchay Mear District Kamchay Mear district is located in the Lower Mekong River floodplain area and is also a high groundwater table region. The survey was conducted in 8 target villages within 3 communes: Krabau Commune: 3 Villages (Tboung Wat, Prey Toul Thmei and Prey Tres); Cheas Commune: 2 Villages (Chhour Thnal and Prey Romeas); and Smoung Chheung Commune: 3 Villages (Laak, Trapeang Skun and Toul Kralagn). This area is one of the most flood-affected by the Mekong River, and villagers often live on the riverbanks. These become islands in the heavy flooding typical of the end of the monsoon season. Villagers plant recession rice in the floodplain as floods retreat. There are also a number of floating communities. Six out of the eight districts of Prey Veng Province are usually flooded in the wet season. The ground water table is high, right up to the surface in the wet season, and around 5-10 meters in the dry season. Around 70% of households have their own wells (poorly constructed), with hand pumps, hence access to water is not a serious problem, though water quality is a concern. Only 7% of households in the province have latrines, most of which are pour-flush, as dry latrines are not acceptable to the community. Kamchay Mear district is typical of the province as a whole. A household well with hand pump is considered essential, but hygiene and sanitation education has not made serious inroads in these communities. The survey team found the general standard of hygiene to be better than in Basedth District of Kampong Speu Province, nevertheless latrine coverage in the sample villages was just 1.5%. Sanitation knowledge was low overall, and hand washing after defecation was reported as 16% for the middle/well-off groups, 52% for the poor groups, and 62% for the women s groups. Community interest in having toilets was quite high, and a program of raised pour-flush toilets could be considered, but as in the other districts surveyed, should be part of a wider water supply and sanitation improvement program. Page 39

45 Figure 21: Poor quality and low dwelling and fish traps, Toul Kralang Village, Smaung Chheung Commune, Kamchay Mear District, Prey Veng Affected population It is common for Cambodian settlement to follow roads and riverbanks because these form the highest point in areas that are prone to flooding, often becoming long thin islands in a flooded sea for periods of time and serving as refuge points for the population. The previous two sections have included the population who live on rivers or riverbanks within the Tonle Sap and Lower Mekong River Floodplains. This section discusses the populations living on rivers or riverbanks outside of the floodplains as seen in the map below. The population considered as living on the riverbanks was those within a close distance of the major rivers datasets for Cambodia. Two analyses were conducted, one for villages within 100m and the second for those within 250m to examine how sensitive the data was to distance. Increasing the buffer distance by 150m increased the total affected population threefold. Figure 22: Women's Focal Group Discussions, Trapeang Skun Village, Smaung Chheung Commune, Kamchay Mear District, Prey Veng Figure 23: Shallow Well with Broken Platform, Toul Kralang Village, Smaung Chheung Commune, Kamchay Mear District, Prey Veng Page 40

46 4.5 Rivers and Riverbanks (major river systems and tributaries) Settlement characteristics Similar to communities above the water and surrounding the Tonle Sap Lake, the river communities homes are stilted houses where the area beneath the house is used for livelihoods and social purposes and the sleeping area is in the enclosed floor upstairs. Animals are often kept under the house. The density of river and riverbank housing remains reasonably constant, with houses tending to be on either side of the road that goes along the riverbank next to or nearby the river. Villagers farm in the areas behind the levees, which often receive floodwaters backing up into them from the major river. Other times, when major river levels are high, local rainfall coinciding at the peak of the rains will flood areas locally. Villagers will often farm along the riverbanks, so-called chamcar farming of vegetables, corn, sugar cane and tobacco. The total estimated population living on riverbanks outside of the Tonle Sap and Lower Mekong River Floodplains is approximately 430,000 people. About one quarter of these are estimated to belong to each category of severity Sanitation facilities and practices The communities rarely have proper latrines. Some toilets in these areas are simple holes on the platforms that discharge directly to the river or lake below. Some communities living on the bank may have simple pour flush toilets but the waste is directly discharged to the river by pipe. River water is used for most basic needs such as drinking, washing, cooking, bathing etc. This is the same river used to dispose of their domestic waste so is a contaminated source. As noted, this area was not visited during the field survey. It is expected that the information provided in regards to general sanitary practices, the high prevalence of open defecation, the anal cleansing methods of leaves, earth or water depending on availability, and the issue of menstrual management by women will be similar to the other areas in the Study. There was not a lot of variance between different localities found in the Study. Page 41

47 [Map 9: River and Riverbank Villages] Page 42

48 Table 6: River and Riverbank Villages Outside Floodplains Modeled Estimated Affected Population Province Total Villages Total Households Total Population Severely Affected Medium Affected Moderately Affected Unaffected (Village) (HH) (Persons) (Persons) (Persons) (Persons) (Persons) Banteay Meanchey 22 5,233 24,100 6,025 6,025 6,025 6,025 Battambang 84 24, ,378 30,095 30,095 30,095 30,095 Kampong Cham Kampong Speu 41 4,165 20,319 5,080 5,080 5,080 5,080 Kampong Thom 15 2,169 10,865 2,716 2,716 2,716 2,716 Kampot 8 2,940 14,619 3,655 3,655 3,655 3,655 Kandal 22 1,887 9,321 2,330 2,330 2,330 2,330 Koh Kong 20 6,421 30,373 7,593 7,593 7,593 7,593 Kratie 49 9,316 46,823 11,706 11,706 11,706 11,706 Mondolkiri , Phnom Penh , Preah Vihear 11 1,141 6,064 1,516 1,516 1,516 1,516 Prey Veng , Pursat 38 7,222 33,944 8,486 8,486 8,486 8,486 Ratanakiri 59 4,524 26,180 6,545 6,545 6,545 6,545 Siem Reap 8 1,163 5,729 1,432 1,432 1,432 1,432 Krong Preah Sihanouk 4 1,015 5,069 1,267 1,267 1,267 1,267 Stung Treng 89 13,313 69,901 17,475 17,475 17,475 17,475 Svay Rieng , Pailin , TOTAL , , , , , , High groundwater areas and swamps (lowlands and floodplains) There are a number of groundwater databases that have been developed over the years in Cambodia and they have recently been centralized in an online database ( ). However, hydro-geological analysis has yet to be undertaken on the data that would allow identification of the specific areas where high groundwater is a problem or their overall extent. It is understood from experience in the field that high groundwater tables, meaning those that come to within 2m of the surface, are common throughout Cambodia, particularly relatively small sub-surface lenses that are isolated from larger aquifers. These exist in lowlands, plateau and highland areas. High groundwater though is particularly prevalent in wetlands, which sometimes represent the groundwater table reaching the surface. More than 30% of the country is considered wetland. Cambodia s wetlands can be divided into four main areas: the Mekong River and its floodplain, the Tonle Sap Great Lake and its floodplain, the tributary river floodplains, and the coastal estuaries. In addition to these primary areas, there are numerous ponds, freshwater swamps and marshes etc. Wetlands are generally covered with shallow and sometimes temporary or intermittent waters and have the water table at, near or above the land surface and are saturated for a long period. The areas surrounding the wetlands usually have high ground water tables and most people in the wetlands use ground water (dug wells/tube well) for their basic needs. Page 43

49 Swamps are flat, lowland areas that are continuously or seasonally inundated as the result of poor natural drainage. Swamps can be either inland swamps which have fresh water near rivers and lakes or tidal-affected swamps near coastal areas or estuaries. These usually have brackish water which cannot be used for domestic purposes. Inland swamps in Cambodia are of two types; inland swamps prone to flooding, and non-flooded swamps that remain continually replenished with groundwater or rainwater. There are more of the flooded swamps than the non-flooded. Swamps in coastal areas are influenced seasonally and periodically by tides, however the areas affected within Cambodia are relatively small as are the sizes of the populations living there. The area of wetlands in Cambodia is similar to the flood-affected areas with the exception of the scattered swamps beyond the floodplain. The alluvial deposits of the Tonle Sap River and Mekong River floodplain are generally good shallow aquifers, with high recharges rates ( 5-20 m 3 /h), however there are large variances in groundwater quality and quantity even over short distances. As noted earlier, the groundwater table is high, generally within m of the surface. At least 25,000 water supply tube wells, for household water supply and for irrigation and about 2,000 manually dug shallow wells are being installed annually and it is expected that this pace will increase with the continued development of the country Settlement characteristics There is no way to describe the settlements for these areas given their prevalence in many different locations and situations other than there general location within the floodplains. While the analysis of the WellMap database identified that the floodplains were likely to have a higher prevalence of high groundwater tables, the field survey showed that this is also an issue in Kampong Speu Province, a typical lowland area on old alluvium. In both places, the groundwater table is high from perched lenses of water which get replenished by the high rainfall in the wet season. Other instances are reported in the literature 15. We can therefore say that this situation is likely to be relatively common and occurs throughout Cambodia Affected population Similarly, it is not possible to estimate the affected population until more spatial hydro-geological analysis is undertaken on the existing databases and gaps in the data are filled. As this situation is more widespread than the others, it can be safely assumed that there are significant numbers of affected people. An indicative analysis was undertaken to provide an estimate of the likely areas affected by high groundwater tables. The Cambodia WellMap database was reviewed, and all data points where either a hand-dug well or where a drilled or other well has a depth of 10m or less were selected to produce the scatter-map on the following page showing all wells within the database and the ones meeting this criteria. A buffer of 250m was set around each of the well points, and this buffer intersected with the village points from the 2008 Census. This provides a basic estimate felt to be a useful initial indicator of the scope of the problem. As seen therein, based on the only partially complete WellMap database, approximately 500,000 people are likely to be affected by high groundwater levels at a minimum, with half of those already living within the floodplain and counted within the other categories, and the remainder outside, mainly in river valleys. 14 Water Environment Partnership in Asia (WEPA) State of water environmental issues: Cambodia as located at the following URL: 15 Robinson, 2007 Page 44

50 Table 7: High Groundwater Villages Modeled Estimated Affected Population Province Total Village s (Village ) Total Household s Total Populatio n High Groun d Water Only (HH) (Persons) (%) High Ground Water Only (Persons ) High GW Plus Other Challengin g Areas High GW Plus Other Challengin g Areas (% of Total) (Persons) Kampong Cham , , % 156, % 119,830 Kampong Chhnang 6 1,615 7, % 2, % 4,880 Kampong Thom 15 1,954 8, % 1, % 7,249 Kandal , , % 60, % 167,176 Kratie , % 1, % 3,245 Phnom Penh 42 9,605 47, % 40, % 6,219 Prey Veng 41 10,074 42, % 3, % 39,312 Pursat 8 1,429 6, % 5, % 866 TOTAL , , % 272, % 348,777 Page 45

51 [Map 10: Potential High Groundwater Village Locations] Page 46

52 4.6.3 Sanitation facilities and practices As noted above, it is not possible to identify a prevailing situation for people who have high ground water tables. It is expected that the situation with rural sanitation as described in the first two sections prevails here as well. For the study survey area, typical situations were described by the participants including: there was only 6.5% toilet coverage among the interviewees; they use earth, leaves and other plants for anal cleansing, while water is generally used for children. They bury children s feces around the house if they see it, but defecate in the forest and scrub. Hand washing was zero for the middle income level villagers but 40% for the poorer ones. Most of the women in the villages used menstrual pads, although some still used cloth. Pads were buried after use Study area: Basedth District The district is located in an upper plateau of rolling terrain on old alluvium. It suffers from drought once in five years on average. The groundwater level is high. The survey was conducted in eight target villages within two communes of Basedth district. These villages were relatively poor for the area, and some had never had any water or sanitation interventions. The locations were as follows: Nitean Commune: Trapeang Rumdenh, Trapeang Sal, Trapeang Khyorng and Trapeang Andoung Villages; and Pou Mreal Commune: Pou, Rumdoh Thmei, Trapeang Khnar and Salam Villages. All were located in the seasonal flooding area and included a number of floating communities. Basedth is one of the eight districts of Kampong Speu province. The district is located around 15Km from national road N 3 or from Thnal Baot town of Takeo province. There is a substantial difference in wealth between the different villages surveyed, varying from very poor to remarkably rich. Basedth district is located in a hilly area which is often subject to drought. Nearly all the surveyed villages had inadequate water supplies, from wells or ponds. The communities highest priority was to improve the water supplies for both domestic use and for irrigation. There was very little interest in sanitation; people were satisfied with their existing arrangement of defecating in forests and rice fields. Overall, the people in mountainous areas and floating communities (not seasonal flooding areas) have water supply as their highest priority for improvement. Very few toilets were found in any of the surveyed villages in Prey Veng and Kampong Speu Provinces, and only about 40% in Kampong Chhnang Province. Page 47

53 Figure 24: Women's Group Meeting, Trapeang Rumdenh Village, Nitean Commune (top); Solid Waste Disposal Problems, Trapeang Andoung Village, Nitean Commune (right); Basic Hand-dug Well, (lower) Rumdoh Thmei Village, Pou M'real Commune, Basedth District, Kampong Speu Page 48

54 Respondents showed awareness of the importance of sanitation for health, but gave it a low priority and only 6.5% had a toilet. Although there was substantial interest in a sanitation program, there was much more interest in a program to help communities with clean water supplies. Figure 25: Preferred Pour-Flush Toilet and Shallow Well without Cover or Platform, Pou Village, Pou M'real Commune, Basedth District, Kampong Speu 4.7 Coastal areas Cambodia s 440 kilometers of coastline is a source of livelihood to some 845,000 people. The coastal areas consist of 21 districts, 152 communes and 705 villages. The area includes Preah Sihanouk, Kampot and Koh Kong provinces, and Kep and Sihanoukville municipalities. Sihanoukville is the mid-point of the coastal area. Rivers in the coastal areas are relatively small and very short and have their sources in the hills about m altitude and divide into estuaries in the delta areas covered with mangroves. These rivers usually are dry in the dry season and the downstream parts of the rivers are saline. However, the level of pollution in the coastal area is indicated not to be high due to the relatively low level of development Settlement characteristics The housing is in a similar pattern to housing communities along the rivers, most are temporary or semi permanent stilt houses to keep them above variances in water levels from tides. As noted, this area was not surveyed during the study, so on-the-ground data could not be gathered Sanitation facilities and practices There is a significant variation in access to sanitation in the coastal districts (low) and districts within urban areas (high). In some remote districts, sanitation facilities do not exist, as well as on the islands off the coast. Where latrines are available, the discharge of the waste is directly to water bodies (coastal, seawater, swamps). The coast is becoming developed and the land is quite valuable, so the situation is in flux. Communities take water from piped water systems, tube and dug wells, and also unsafe sources such as rivers, ponds or other surface water sources. There is significant variation in access to water in the coastal provinces and districts with the highest level of access found in urban areas. The lack of safe 16 WEPA/Water Environment Partnership in Asia, Cambodia Stated of Environmental Issues, Page 49

55 water not only impacts health, it imposes economic stress on households which have to collect water over larger distances at high costs Affected population As noted, the affected population along the coast is relatively small in comparison to the other challenging areas in Cambodia. The areas are similarly challenging due to high groundwater tables from the sea, shifting shorelines and heavy storms, and face an additional difficulty in that concrete and reinforcement for structures need to be protected against salt corrosion. The estimated population living in the coastal areas was around 170,000 people. Table 28: Coastal Areas Villages Modeled Estimated Affected Population Province Total Villages Total Households Total Population Severely Affected Medium Affected Moderately Affected Unaffected (Village) (HH) (Persons) (Persons) (Persons) (Persons) (Persons) Kampot 31 9,626 47,535 11,884 11,884 11,884 11,884 Koh Kong 75 15,962 77,129 19,282 19,282 19,282 19,282 Krong Preah Sihanouk 27 8,434 41,517 10,379 10,379 10,379 10,379 Krong Kep 3 1,307 6,658 1,665 1,665 1,665 1,665 TOTAL , ,839 43,210 43,210 43,210 43,210 Page 50

56 [Map 11: Coastal Topography and Villages] Page 51

57 5 Summary of Key Findings Scope of the problem Widespread flooding from the Mekong River and Tonle Sap systems occurs every year in Cambodia but there is substantial local variation in the severity and duration of the impacts. Flooding, high groundwater tables, heavy rainfall and poor drainage all make it difficult to maintain good standards of hygiene and contribute to a high incidence of diarrheal disease. Hygiene knowledge, attitudes and practices Most respondents in the study communities displayed knowledge of the health implications of poor sanitation but this was not matched by their ability or willingness to construct and use improved latrines. There were wide-ranging responses to questions about the disposal of feces. Overall, it seems that a majority of households bury both adult and children s feces close to the house, with only a small minority burying it in the forests or rice fields. The majority of children under five defecate openly without restraint. Existing sanitation services There were very few toilets in most of the study communities and none that provided appropriate year-round sanitation solutions. In the seasonally flooded areas, latrine coverage was relatively higher but again the facilities could not function during flood periods. Cheap options such as simple open pits with wooden platforms and shelters do not provide a suitable option in these locations as they can spread pathogens when they overflow during times of flooding or very high ground water levels. Appropriate solutions are likely to be more expensive than in normal locations due to the need to prevent latrines overflowing, for example by raising the platform and/or installing sealed pits or tanks. Demand for improved sanitation The communities visited did not regard sanitation as a priority need; they were more concerned about livelihoods, food security and improved infrastructure and basic services, especially water supply, roads, education and schools. It is likely, therefore, that programmes which support water supply improvements as well as sanitation will be better received than stand-alone sanitation projects. In very few of the villages surveyed were respondents willing to make cash as well as labor contributions for the construction of a toilet even if it was accompanied by a reliable water supply. The percentage of respondents willing to make just cash contributions only was somewhat higher. Page 52

58 Some households had simple pit latrines but these were problematic when flooding occurred and there was an overwhelming rejection of any type of dry toilet due primarily to concerns about odor issues, whether real or imagined. Pour-flush toilets were the preferred option in all cases. The challenge of developing affordable options is considerable. In the recent WSP demand study, more than half of village respondents indicated that they would be willing to pay as much as $25 towards the cost of constructing a latrine, but 40% said they could only afford $10. So far, no improved latrine designs suitable for challenging areas are available at $25 or less. The priority attached to improved sanitation appears to be influenced by: village size and population density; proximity to towns and cities; socio-economic conditions - particularly wealth and education; availability of water; and proximity and access to bushland and paddy fields for open defecation. Page 53

59 6 Conclusions and recommendations Many of the findings of this study confirm those of previous assessments of general sanitation needs in Cambodia 17 - particularly the relatively low level demand for improved sanitation, affordability problems and the preference for pour-flush (hence higher cost) latrines rather than dry technology options. Since sanitation is a relatively low priority for communities in challenging areas, developing new toilet designs might not, on its own, result in sanitation improvements in these locations. There is evidently a need also to generate demand for improved facilities. CLTS has a great deal to offer here, as has ongoing work on sanitation marketing - particularly the easy latrine initiative, which has increased both the demand for, and supply of, affordable toilets. The project has already demonstrated that improved toilet designs costing just $35 are achievable, although the ones in use are not designed for use in challenging areas. The majority of latrines constructed in rural areas are funded and built privately, not via donor-funded projects. With this in mind, potential solutions solution should be marketed through local artisans to establish long-term, commercially viable supply chains. The work of IDE and Lien Aid in developing marketbased approaches to mobilize demand, train local suppliers and support the supply chain has demonstrated promise in building a supporting framework and network for the marketing, supply and maintenance of low-cost options. It seems unlikely that one could design a latrine that addresses the technical problems in challenging areas for $10 (the ceiling proposed by the 40% of respondents in the World Bank affordability study) or even $25. This being the case, the case for providing some form of subsidy to poor households in challenging areas warrants careful consideration, even though this runs against the principles underpinning CLTS, the use of which is central to national sanitation strategy. 6.1 Recommendations for Phase 2 The implementation of a successful project to achieve the goal of improving sanitation in these challenging areas will clearly require a long-term and sustained effort. The large numbers of affected people and the importance of addressing sanitation for public health and prosperity provide justification for this to be done. A specific objective of Phase 2 should be to develop appropriate technology options that are as cheap as possible; certainly less than $ This includes WSP-EAP, July 2002 Learning What Works for Sanitation Revisiting Sanitation Successes in Cambodia and WSP, October 2008 Sanitation Demand and Supply in Cambodia Identifying Constraints to Increasing Sanitation Coverage. Page 54

60 Ideally such an effort would be harmonised with ongoing work to scale up CLTS in Cambodia, thereby ensuring an emphasis on generating demand for improved sanitation and working closely with affected communities to identify potential solutions. Given the size of the challenging areas and increasing investments in sanitation promotion in the country, it should not be difficult to locate suitable sites and organizations to partner with. A market-based approach to the development of supply chains via local masons and hardware suppliers is also recommended, and here too emerging lessons from the ongoing work of development agencies in rural areas should inform the process. The easy latrine, already developed and being marketed in Cambodia is an obvious point of reference for the design work, and it may also be useful to review designs developed or used in challenging areas of other countries. Another possibility that has been raised is to have an open competition among Cambodian engineers or within the communities to develop suitable designs to address these problems. This would mobilize public interest and engage Cambodia's young engineers and private sector. A related issue that may also prove useful to the sector would be to establish an online sanitation database and map similar to the WellMap system, to improve knowledge and understanding of sanitation coverage, activities, designs and other relevant issues. Page 55

61 7 Annex 1: Lake Floodplain Tonle Sap: Socio-Economic and WATSAN Data Tonle Sap Floodplain by Province Province Villages Table 8: Tonle Sap Lake and Floodplain, Socio-Economic Summary Data Total Households Total Population Average Household Size Female- Headed Households Dependency Ratio # HH Persons Persons/HH % Index Banteay Meanchey , , Battambang , , Kampong Chhnang , , Kampong Thom , , Pursat , , Siem Reap , , Oddar Meanchey 11 1,798 8, TOTAL 1, ,013 1,363, Tonle Sap Floating Villages by Province Province Villages Table 8: Tonle Sap Floating Villages, Socio-Economic Summary Data Total Households Total Population Average Household Size Female- Headed Households Dependency Ratio # HH Persons Persons/HH % Index Banteay Meanchey Battambang 10 2,726 14, Kampong Chhnang 74 15,222 78, Kampong Thom 13 1,903 9, Pursat 16 2,631 13, Siem Reap 37 6,201 32, TOTAL , , Page 56

62 Table 10: Tonle Sap Floodplain Villages, Sanitation Options by JMP Sanitation Ladder Province Total Households No Toilet Other Toilet Open Defecation/ Unimproved Toilet Options Pit Latrine Sewage System Septic Tank Improved Toilet Options HH HH % HH % % of HH HH % HH % HH % % of HH Banteay Meanchey 49,942 35, % % 70.6% 1, % 5, % 7, % 29.0% Battambang 47,134 27, % % 59.0% 3, % 6, % 9, % 40.7% Tonle Sap Floodplain by Province Kampong Chhnang 29,894 21, % % 73.4% % 3, % 4, % 26.0% Kampong Thom 70,793 46, % % 67.3% 11, % 3, % 7, % 32.2% Pursat 33,520 26, % % 81.4% 1, % 1, % 3, % 18.4% Siem Reap 51,932 42, % % 82.5% 1, % 4, % 2, % 17.2% Oddar Meancheay 1,798 1, % % 79.4% % TOTAL 285, , % 2, % 71.7% 19, % 26, % 34, % 28.0% Page 57

63 Table 11: Tonle Sap Floating Villages, Sanitation Options by JMP Sanitation Ladder Province Total Households No Toilet Other Toilet Open Defecation/ Unimproved Toilet Options Pit Latrine Sewage System Septic Tank Improved Toilet Options HH HH % HH % % of HH HH % HH % HH % % of HH Banteay Meanchey % 0 0.0% 98.3% 0 0.0% 0 0.0% 0 0.0% 0.0% Battambang 2,726 1, % % 94.3% % % 2 0.1% 1.5% Tonle Sap Floating Villages by Province Kampong Chhnang 15,222 13, % % 93.4% % % % 6.0% Kampong Thom 1,903 1, % % 79.7% % 9 0.5% 7 0.4% 17.2% Pursat 2,631 1, % % 81.5% % % 9 0.3% 15.2% Siem Reap 6,201 5, % % 89.0% % % % 10.3% TOTAL 28,743 23, % 2, % 90.6% 1, % % % 8.1% Page 58

64 Table 12: Tonle Sap Floodplain Villages, Improved Water Supply Options Province Total Households Piped Water System Tube Wells Protected Water Source Protected Water Supply Options Water (Protected or Not) in HH or Nearby HH HH % HH % HH % % HH % Banteay Meanchey 49,942 4, % 5, % 1, % 22.9% 26, % Battambang 47, % 4, % 1, % 15.9% 33, % Kampong Chhnang 29,894 1, % 9, % 1, % 42.4% 19, % Tonle Sap Floodplain by Province Kampong Thom 70,793 3, % 8, % 6, % 26.7% 49, % Pursat 33,520 1, % 2, % 2, % 19.3% 19, % Siem Reap 51,932 1, % 16, % 4, % 43.1% 29, % Oddar Meanchey 1, % % % 33.5% % TOTAL 285,013 13, % 47, % 18, % 28.1% 178, % Page 59

65 Table 13: Tonle Sap Floodplain Villages,Unimproved Water Supply Options Tonle Sap Floodplain by Province Tonle Sap Floating Villages by Province Province Total Households Unprotected Water Source Spring Water Source Purchased Water Rain Water Jar Spring Water Source Other Water Source Uncertain Water Supply Water Far Away HH HH % HH % HH % HH HH HH % HH % Banteay Meanchey 49,942 4, % 31, % 1, % , % 5, % Battambang 47,134 13, % 20, % 3, % ,677 1, % 3, % Kampong Chhnang 29,894 11, % 3, % % 193 3, % 7, % Kampong Thom 70,793 35, % 14, % % ,198 1, % 6, % Pursat 33,520 8, % 15, % 1, % , % 4, % Siem Reap 51,932 20, % 6, % % 287 6,463 2, % 9, % Oddar Meanchey 1, % % % % 1, % TOTAL 285,013 93, % 91, % 8, % 2,378 91,876 7, % 37, % Table 14: Tonle Sap Floating Villages, Improved Water Supply Options Protected Water Province Total Piped Water Protected Water (Protected or Tube Wells Households System Water Source Supply Not) in HH or Options Nearby HH HH % HH % HH % % HH % Banteay Meanchey % 0 0.0% 0 0.0% 0.0% % Battambang 2, % 5 0.2% 0 0.0% 0.3% 2, % Kampong Chhnang 15, % % % 7.7% 12, % Kampong Thom 1, % % 3 0.2% 2.3% 1, % Pursat 2, % % % 2.8% 2, % Siem Reap 6, % % % 15.7% 4, % TOTAL 28, % 1, % % 7.9% 23, % Table 15: Tonle Sap Floating Villages, Unimproved Water Supply Options Page 60

66 Province Total Households Unprotected Water Source Spring Water Source Purchased Water Rain Water Jar Other Water Source Uncertain Water Supply Water Far Away Tonle Sap Floating Villages by Province HH HH % HH % HH % HH HH % HH % Banteay Meanchey % % 0 0.0% % % Battambang 2, % 2, % 6 0.2% % % Kampong Chhnang 15, % 12, % % % 2, % Kampong Thom 1, % 1, % 1 0.1% % % Pursat 2, % 2, % 0 0.0% % % Siem Reap 6, % 4, % % % 1, % TOTAL 28, % 24, % % % 4, % Page 61

67 8 Annex 2: River Floodplain Lower Mekong River: Socio-Economic and WATSAN Data Table 16: Lower Mekong River Floodplain Villages, Socio-Economic Summary Data Province Villages Total Households Total Population Average Household Size Female- Headed Households Dependency Ratio # HH Persons Persons/HH % Index Kampong Cham , , Kampong Speu 9 1,249 6, Kampot 96 21,878 96, Kandal ,495 1,080, Lower Mekong River Floodplain Villages Kratie , , Phnom Penh , , Prey Veng , , Svay Rieng , , Takeo , , Krong Kep 6 2,226 11, TOTAL 3, ,759 4,095, Page 62

68 Table 17: Lower Mekong River Floodplain Villages, Sanitation Options by JMP Sanitation Ladder Province Total Households No Toilet Other Toilet Open Defecation/ Unimproved Toilet Options Pit Latrine Sewage System Septic Tank Improved Toilet Options HH HH % HH % % of HH HH % HH % HH % % of HH Kampong Cham 165, , % 1, % 75.5% 5, % 8, % 25, % 24.0% Kampong Speu 1, % 1 0.1% 31.2% 7 0.6% % % 67.1% Kampot 21,878 17, % % 80.8% 1, % 1, % 1, % 19.1% Lower Mekong River Floodplain Villages Kandal 221, , % 1, % 53.9% 14, % 29, % 56, % 45.3% Kratie 29,582 17, % % 60.6% 2, % 1, % 7, % 38.6% Phnom Penh 79,212 10, % % 13.9% % 38, % 25, % 81.6% Prey Veng 181, , % 2, % 82.7% 9, % 9, % 11, % 16.9% Svay Rieng 67,109 50, % % 75.4% 5, % 4, % 6, % 24.2% Takeo 125,949 95, % % 76.8% 3, % 10, % 15, % 22.9% Krong Kep 2,226 1, % % 74.3% % % % 25.2% TOTAL 895, , % 7, % 65.9% 43, % 103, % 150, % 33.2% Page 63

69 Table 18: Lower Mekong River Floodplain Villages, Improved Water Supply Options Province Total Households Piped Water System Tube Wells Protected Water Source Protected Water Supply Options Water (Protected or Not) in HH or Nearby HH HH % HH % HH % % HH % Kampong Cham 165,610 13, % 37, % 7, % 35.4% 98, % Kampong Speu 1, % % % 56.8% % Kampot 21,878 1, % 1, % 1, % 17.3% 12, % Kandal 221,495 33, % 46, % 5, % 38.3% 155, % Lower Mekong River Floodplain Villages Kratie 29,582 7, % 3, % 1, % 41.4% 18, % Phnom Penh 79,212 53, % 3, % 1, % 73.4% 64, % Prey Veng 181,449 11, % 137, % 2, % 83.8% 155, % Svay Rieng 67,109 3, % 56, % 1, % 92.1% 61, % Takeo 125,949 6, % 39, % 4, % 40.2% 71, % Krong Kep 2, % % % 8.0% % TOTAL 895, , % 326, % 24, % 53.9% 640, % Page 64

70 Table 19: Lower Mekong River Floodplain Villages, Unimproved Water Supply Options Province Total Households Unprotected Water Source Spring Water Source Purchased Water Rain Water Jar Other Water Source Uncertain Water Supply Water Far Away HH HH % HH % HH % HH HH % HH % Kampong Cham 165,610 35, % 26, % 41, % 1,009 1, % 65, % Kampong Speu 1, % % % % % Kampot 21,878 8, % 9, % % % 8, % Lower Mekong River Floodplain Villages Kandal 221,495 6, % 86, % 38, % 1,563 1, % 64, % Kratie 29,582 4, % 4, % 8, % % 10, % Phnom Penh 79, % 4, % 12, % % 11, % Prey Veng 181,449 4, % 18, % 2, % 1,059 2, % 25, % Svay Rieng 67,109 1, % % % 344 2, % 5, % Takeo 125,949 19, % 48, % 4, % 2,100 1, % 53, % Krong Kep 2, % 1, % % % 1, % TOTAL 895,759 80, % 200, % 108, % 6,699 9, % 247, % Page 65

71 9 Annex 3: Rivers and Riverbanks Major Rivers and Tributaries: Socio-Economic and WATSAN Data Table 20: Riverbank Villages, Socio-Economic Summary Data Province Villages Total Households Total Population Average Household Size Female-Headed Households Dependency Ratio Riverbank Villages # HH Persons Persons/HH % Index Banteay Meanchey 22 5,233 24, Battambang 84 24, , Kampong Cham Kampong Speu 41 4,165 20, Kampong Thom 15 2,169 10, Kampot 8 2,940 14, Kandal 22 1,887 9, Koh Kong 20 6,421 30, Kratie 49 9,316 46, Mondolkiri , Phnom Penh , Preah Vihear 11 1,141 6, Prey Veng , Pursat 38 7,222 33, Ratanakiri 59 4,524 26, Siem Reap 8 1,163 5, Krong Preah Sihanouk 4 1,015 5, Stung Treng 89 13,313 69, Svay Rieng , Pailin , TOTAL , , Page 66

72 Table 21: Riverbank Villages, Sanitation Options by JMP Sanitation Ladder Province Total Households No Toilet Other Toilet Open Defecation/ Unimproved Toilet Options Pit Latrine Sewage System Septic Tank Improved Toilet Options Riverbank Villages HH HH % HH % % of HH HH % HH % HH % % of HH Banteay Meanchey 5,233 3,043 58% 20 0% 59% 172 3% 1,415 27% % 41% Battambang 24,604 9,268 38% 330 1% 39% 1,490 6% 6,259 25% 7,063 29% 60% Kampong Cham % 1 0% 86% 16 8% 0 0% 12 6% 14% Kampong Speu 4,165 2,943 71% 65 2% 72% 272 7% 327 8% % 28% Kampong Thom 2,169 1,534 71% 1 0% 71% 77 4% 32 1% % 29% Kampot 2, % 7 0% 31% 217 7% % % 68% Kandal 1,887 1,189 63% 1 0% 63% 23 1% % % 36% Koh Kong 6,421 3,086 48% 450 7% 55% 193 3% 1,069 17% 1,574 25% 44% Kratie 9,316 8,044 86% 63 1% 87% 342 4% 224 2% 596 6% 12% Mondolkiri % 0 0% 94% 2 1% 2 1% 14 5% 6% Phnom Penh % 7 2% 27% 0 0% 10 2% % 72% Preah Vihear 1,141 1,073 94% 0 0% 94% 2 0% 54 5% 1 0% 5% Prey Veng % 1 0% 76% 92 22% 5 1% 0 0% 23% Pursat 7,222 6,087 84% 6 0% 84% 88 1% 451 6% 582 8% 16% Ratanakiri 4,524 3,860 85% 302 7% 92% 214 5% 72 2% 62 1% 8% Siem Reap 1, % 0 0% 58% 21 2% 85 7% % 41% Krong Preah Sihanouk 1, % 1 0% 68% 70 7% % % 31% Stung Treng 13,313 8,608 65% 229 2% 66% 625 5% 1,218 9% 2,478 19% 32% Svay Rieng % 0 0% 95% 0 0% 2 1% 13 4% 5% Pailin % 0 0% 98% 1 0% 2 0% 6 1% 2% TOTAL 87,158 52,564 60% 1,484 2% 62% 3,917 4% 12,559 14% 16,042 18% 37% Page 67

73 Table 22: Riverbank Villages, Improved Water Supply Options Province Total Households Piped Water System Tube Wells Protected Water Source Protected Water Supply Options Water (Protected or Not) in HH or Nearby HH HH % HH % HH % % HH % Banteay Meanchey 5, % 2,160 41% 112 2% 46% 4,143 79% Battambang 24,604 5,791 24% 4,190 17% 621 3% 43% 17,202 70% Kampong Cham % 43 21% 79 39% 61% % Kampong Speu 4, % 261 6% 116 3% 15% 3,102 74% Kampong Thom 2, % 182 8% % 28% 1,420 65% Kampot 2,940 1,842 63% 67 2% 33 1% 66% 2,443 83% Riverbank Villages Kandal 1, % % % 38% 1,015 54% Koh Kong 6,421 1,860 29% 143 2% 400 6% 37% 4,658 73% Kratie 9, % 852 9% 66 1% 15% 5,660 61% Mondolkiri % % 3 1% 42% % Phnom Penh % 47 12% % 58% % Preah Vihear 1, % % 3 0% 22% % Prey Veng % % 4 1% 87% % Pursat 7, % 1,057 15% 522 7% 27% 4,126 57% Page 68

74 Ratanakiri 4, % 428 9% 276 6% 16% 3,189 70% Siem Reap 1, % 15 1% 76 7% 22% % Krong Preah Sihanouk 1, % 34 3% 94 9% 25% % Stung Treng 13, % 1,079 8% 279 2% 15% 8,256 62% Svay Rieng % % 6 2% 91% % Pailin % 57 14% 1 0% 14% % TOTAL 87,158 11,991 14% 11,967 14% 3,378 4% 31% 58,137 67% Page 69

75 Table 23: Lower Riverbank Villages, Unimproved or Uncertain Water Supply Options Province Total Households Unprotected Water Source Shallow Well Water Source Purchased Water Rain Water Jar Other Water Source Uncertain Water Supply Water Far Away HH HH % HH % HH % HH HH % HH % Banteay Meanchey 5, % 2,231 43% 2 0% % 1,080 21% Battambang 24,604 2,070 8% 7,126 29% 3,912 16% % 7,208 29% Kampong Cham % 0 0% 0 0% 0 0 0% 49 24% Kampong Speu 4, % 2,648 64% % % 1,059 25% Kampong Thom 2,169 1,124 52% % 2 0% % % Kampot 2, % 154 5% % % % Riverbank Villages Kandal 1, % % % % % Koh Kong 6,421 1,825 28% 222 3% 1,830 29% % 1,714 27% Kratie 9, % 7,028 75% 611 7% % 3,609 39% Mondolkiri % % 13 5% % % Phnom Penh % 33 8% 71 18% % 70 17% Preah Vihear 1, % % 10 1% % % Prey Veng % 2 0% 0 0% % 47 11% Pursat 7,222 1,536 21% 3,209 44% 414 6% % 3,088 43% Ratanakiri 4, % 3,411 75% 0 0% % 1,321 29% Page 70

76 Siem Reap 1, % 73 6% % % % Krong Preah Sihanouk 1, % % % % % Stung Treng 13, % 10,372 78% 135 1% % 4,902 37% Svay Rieng % 25 8% 0 0% 0 0 8% 25 8% Pailin % % 0 0% % % TOTAL 87,158 9,683 11% 39,129 45% 8,655 10% 672 1,091 57% 28,429 33% Page 71

77 10 Annex 4: High Groundwater and Drought-Prone Areas, Old Alluvial Lowlands: Socio-Economic / WATSAN Data Table 24: High Groundwater Villages, Socio-Economic Summary Data Province Villages Total Households Total Population Average Household Size Female- Headed Households Dependency Ratio # HH Persons Persons/HH % Index Kampong Cham , , Kampong Chhnang 6 1,615 7, Kampong Speu Kampong Thom 15 1,954 8, Kandal , , High Groundwater Villages Kratie , Phnom Penh 42 9,605 47, Prey Veng 41 10,074 42, Pursat 8 1,429 6, Ratanakiri Takeo TOTAL , , Page 72

78 Table 25: High Groundwater Villages by JMP Sanitation Ladder Province Total Households No Toilet Other Toilet Open Defecation/ Unimproved Toilet Options Pit Latrine Sewage System Septic Tank Improved Toilet Options HH HH % HH % % of HH HH % HH % HH % % of HH Kampong Cham 60,407 42, % % 71.3% 5, % 3, % 8, % 28.4% Kampong Chhnang 1, % 6 0.4% 61.0% % % % 38.3% Kampong Speu % 0 0.0% 84.4% 6 4.3% % 6 4.3% 15.6% Kampong Thom 1,954 1, % % 74.9% % % % 25.1% Kandal 46,749 21, % % 47.5% 2, % 8, % 13, % 51.3% High Groundwater Villages Kratie % % 38.9% % % % 60.7% Phnom Penh 9,605 2, % % 21.9% % 2, % 4, % 75.9% Prey Veng 10,074 7, % % 80.8% % % % 18.7% Pursat 1,429 1, % 3 0.2% 75.2% % % % 24.6% Ratanakiri % 0 0.0% 99.2% 0 0.0% 0 0.0% 1 0.8% 0.8% Takeo % 0 0.0% 89.3% 0 0.0% 0 0.0% % 10.7% TOTAL 133,191 78, % 1, % 59.9% 9, % 15, % 28, % 39.3% Page 73

79 Table 26: High Groundwater Villages, Improved Water Supply Options Province Total Households Piped Water System Tube Wells Protected Water Source Protected Water Supply Options Water (Protected or Not) in HH or Nearby HH HH % HH % HH % % HH % Kampong Cham 60,407 2, % 8, % 5, % 28.4% 44, % Kampong Chhnang 1, % % % 46.2% 1, % Kampong Speu % % % 53.9% % Kampong Thom 1, % % % 37.2% 1, % Kandal 46,749 5, % 11, % 4, % 45.4% 32, % High Groundwater Villages Kratie % % % 56.6% % Phnom Penh 9,605 2, % 3, % % 71.2% 7, % Prey Veng 10, % 7, % % 78.0% 8, % Pursat 1, % % % 25.7% 1, % Ratanakiri % 3 2.4% 6 4.8% 8.1% 6 4.8% Takeo % 0 0.0% 2 1.7% 4.1% 5 4.1% TOTAL 133,191 11, % 32, % 11, % 41.7% 96, % Page 74

80 Table 28: High Groundwater Villages, Unimproved Water Supply Options Province Total Households Unprotected Water Source Spring Water Source Purchased Water Rain Water Jar Other Water Source Uncertain Water Supply Water Far Away HH HH % HH % HH % HH HH % HH % Kampong Cham 60,407 33, % 3, % 5, % % 15, % Kampong Chhnang 1, % % % % % Kampong Speu % % 0 0.0% % % Kampong Thom 1, % % 0 0.0% % % Kandal 46,749 8, % 11, % 4, % % 13, % High Groundwater Villages Kratie % % % % % Phnom Penh 9, % % 1, % % 1, % Prey Veng 10, % 1, % 9 0.1% % 1, % Pursat 1, % % % % % Ratanakiri % % 0 0.0% % % Takeo % % % % % TOTAL 133,191 44, % 17, % 12, % 927 1, % 35, % Page 75

81 11 Annex 5: Coastal Areas Table 29: Coastal Villages, Socio-Economic Summary Data Coastal Villages Province Villages Total Households Total Population Average Household Size Female- Headed Households Dependency Ratio # HH Persons Persons/HH % Index Kampot 31 9,626 47, Koh Kong 75 15,962 77, Krong Preah Sihanouk 27 8,434 41, Krong Kep 3 1,307 6, TOTAL , , Province Total Households Table 30: Coastal Villages, Sanitation Options by JMP Sanitation Ladder No Toilet Other Toilet Open Defecation/ Unimproved Toilet Options Pit Latrine Sewage System Septic Tank Improved Toilet Options HH HH % HH % % of HH HH % HH % HH % % of HH Kampot 9,626 6, % % 70.5% % % 1, % 29.2% Coastal Villages Koh Kong 15,962 10, % % 69.6% % 1, % 2, % 29.8% Krong Preah Sihanouk 8,434 5, % % 67.3% % % 1, % 31.2% Krong Kep 1, % % 75.7% 3 0.2% % % 23.6% TOTAL 35,329 23, % 1, % 69.5% 1, % 3, % 5, % 29.7% Table 31: Coastal Villages, Improved Water Supply Options Page 76

82 Coastal Villages Province Total Households Piped Water System Tube Wells Protected Water Source Protected Water Supply Options Water (Protected or Not) in HH or Nearby HH HH % HH % HH % % HH % Kampot 9, % % % 19.9% 4, % Koh Kong 15,962 2, % % 1, % 32.4% 9, % Krong Preah Sihanouk 8,434 1, % % 1, % 45.5% 4, % Krong Kep 1, % 7 0.5% 8 0.6% 1.6% % TOTAL 35,329 5, % 1, % 3, % 31.0% 19, % Table 32: Coastal Villages, Unimproved Water Supply Options Province Total Households Unprotected Water Source Spring Water Source Purchased Water Rain Water Jar Other Water Source Uncertain Water Supply Water Far Away HH HH % HH % HH % HH HH % HH % Kampot 9,626 3, % 2, % 1, % % 5, % Coastal Villages Koh Kong 15,962 6, % % 3, % % 6, % Krong Preah Sihanouk 8,434 2, % % 1, % % 3, % Krong Kep 1, % % 3 0.2% % % TOTAL 35,329 13, % 3, % 6, % % 15, % Page 77

83 12 Annex 5: Survey Instrument The survey utilized the formation of focal groups through which to obtain community level information and opinions. Focal groups were formed in each village as follows: Leadership group village heads and administrative committee, Rich and middle economic level households Poor households Women s group The purpose of the focal groups was to identify differences in opinion and practice (KAP) that may be due to socio-economic status. The enumerators, working together with the MRD staff, first met with representatives from the whole village (leadership, rich/middle/poor and women s groups) for approximately 30 minutes to introduce the project and outline the reasons for the survey, and the focal group methodology. Figure XX: Village Meetings, Trapeang Sala Village, Nitean Commune, Basedth District, Kampong Speu The community then broke up into the four groups and moved to separate locations around the village. Each group met for approximately one hour. Rich and middle income groups were combined due to time pressure. The questionnaire was used to guide discussions. The enumerators recorded answers/responses directly onto the forms during the meetings. A separate questionnaire was used for the women s group. This questionnaire asked about the disposal of sanitary napkins and children s toilet habits. The questionnaire used can be found in both English and Khmer in Annex 1. The enumerators, working together with the Ministry of Rural Development staff, first met with representatives from the whole village (leadership, rich/middle/poor and women s groups) for minutes to introduce the project and outline the reasons for the survey. The community then broke up into the four groups and moved to separate locations around the village. Each group met for approximately one hour. Rich and middle income groups were combined due to time pressure. It should be noted that while the Lao PDR administration at village level categorizes inhabitants into poor, middle and rich households, the Cambodian government system seems not to do this The questionnaire was used to guide discussions. The enumerators recorded answers/responses directly onto the forms during the meetings. A separate questionnaire was used for the women s group. This questionnaire asked about the disposal of sanitary napkins and children s toilet habits. The questionnaire used follows. 78

84 District level District name: Province: Total populations HH Poor % with sanitation No. Poor villages HH Ave % with sanitation No Total villages HH Better off % with sanitation Current Watsan situation/issues Current Watsan programs Future plans for Watsan Page 79

85 Village Leadership Group : No HHs in village No Well off HHs No Average HHs No Men No Women Total Children under 12 Criteria used Sanitation type Main livelihood activities Criteria used Sanitation type Main livelihood activities No Poor HHs Criteria Sanitation type Main livelihood activities No HHs with toilets in village % Main health issues in community Domestic water source Type of toilet Village Dispensary Staff Water and sanitation illnesses/ issues related statistics : Wet season Dry season Wet season use Y/N Dry season use Y/N Distance in kms to nearest health station Boiled or not? Comment Travel time Wet season Dry season Distance from village in minutes Wet Season Dry season Page 80

86 Villagers Group Poor Level Average HH GDP Surplus annual income % of group HHs with toilet Yes No If yes, can use in wet season? If no, what method is used? Do children use toilets Do people wash hands after defecating Yes % No% Are there any problems with existing sanitation practices Can poor sanitation cause sickness? % Yes % No Is sanitation important Yes % No% Why What could be done to change the sanitation status? Faeces disposal method % % % Anal cleansing method Page 81

87 Villagers Group Better-off Level Average HH GDP Surplus annual income % of group HHs with toilet Yes No If yes, can use in wet season? If no, what method is used? Do children use toilets Do people wash hands after defecating Yes % No% Are there any problems with existing sanitation practices Can poor sanitation cause sickness? % Yes % No Is sanitation important Yes % No% Why What could be done to change the sanitation status? Faeces disposal method % % % Anal cleansing method Page 82

88 Women s Focal Group (contains a special question) Average HH GDP Surplus annual income % of group HHs with toilet Yes No If yes, can use in wet season? If no, what method is used? Do children use toilets Do people wash hands after defecating Yes % No% Are there any problems with existing sanitation practices Can poor sanitation cause sickness? % Yes % No Is sanitation important Yes % No% Why What could be done to change the sanitation status? What are current menstrual hygiene practices cleaning, disposal? Anal cleansing method Page 83

89 13 Annex 6: Challenging Areas Village Survey Data & Maps 6.1. Tonle Sap Floating and Floodplain Villages Baribou District, Kampong Chhnang Province Page 84

90 Map 12: Selected Study Villages, Baribou District, Kampong Chhnang Province Page 85

91 Table 33: Baribou District General Summary Baribou District 54,714 pop HH Poor 3,611 HHs No. Poor villages 54 Villages HH Ave 3,658 HHs No Total villages 64 Villages ( 11 Communes) HH Better off 3,453 HHs Current Watsan situation/issues Current Watsan programs % with sanitation 20% % with sanitation 30% % with sanitation 50% # of Toilets No Data # of Toilets No Data # of Toilets 1,455 Toilet in total For the Tonle Sap Lowland Rural Development Project, there are four projects in the following communes: Melum commune, Kampong Preah commune, Korky commune, Onchhahn Rong commune Table 34: Baribou District Surveyed Village Data Characteristics Villages Svay Koy Chheung Khnar Kampong Our Serey Melum Toul Thlork Totals Ave Population HHs Male % Female % Under nd % % HH with toilets % Hand washing middle economic 8/12 10/10 10/10 2/9 9/9 No Data 39/50 78% level Poor economic level hand wash 0/10 7/10 10/10 0/8 10/10 9/14 36/62 58% Women hand wash 2/10 6/11 10/10 5/9 2/10 6/14 31/64 48% Page 86

92 Table 35: Baribou District Surveyed Village Sanitation Behaviour by Wealth Group Svay Koy Chheung Khnar Kampong Our Serey Melum Toul Thlork Middle/ Rich 8/12 had toilets, 6 used the 7/10 group members No toilets. All defecate 1/9 has toilet. 2/9 3/9 have toilets. 6/9 No Data Economic Level toilets in dry season. In had toilets. 3 defecated into water. All wash wash hands after defecate near home times of flood toilets are unusable. 8/12 wash after defecating. 3 bury feces, 9 leave them for animals to clean up. in rice fields. All washed hands after defecation. Those who have toilets cleaned with water, those hands after defecation. defecating. and bury feces. 9/9 wash hands after defecation. Poor Economic Level Women Travel time to health centre Disposal of feces No toilets (of10). No hand washing. Many use filtered water (Hagar). Boiling is rare. No toilets (of 10). Defecate in forest (dry season), around house (wet season). All feces buried when near house. 2/10 wash hands. All bury children s feces. 7/10 use menstrual pads which are buried after use. 3 use multiple layers of clothing. 2kms: 15 mins both wet and dry seasons Feces are eaten by dogs, chickens and ducks without used leaves. None had toilets; 7/10 washed hands after defecation. 6/11 had toilets, those with toilets wash hands, those without do not. All use menstrual pads, which are buried after use. Children s feces are buried. 4kms: 10 mins dry, 20 mins wet season. Feces are eaten by dogs, chickens and ducks No toilets. All defecate into water. All wash hands after defecation. 1/10 had a toilet. In dry season they defecate on land. All use pads, which are thrown into water or mangroves. Children defecate into water. Defecation into water is accompanied by hand washing, on land is not. 10 kms: 1 hr wet season, 2 hrs dry season. Into water. 0/8 has toilet. 0/8 hand washing. 1/9 has a toilet. 50% practice hand washing. All group members ceased menstruation. 2.5 kms: 10 mins by motorbike When defecating near house feces are buried. 3/10 have toilets 7/10 defecate near house and bury feces. 10/10 wash hands after defecation. 2/10 have toilets. 8/10 defecate near house or in forest and bury feces if near house. 9/10 use menstrual pads and bury. 1/10 uses cloths. 5 kms: 30 mins by bicycle and 15 by motorcycle. When defecating near 9/14 have toilets. Many of these cannot be used in the wet season. 9/14 wash hands after defecating. When defecating near the house feces are buried. 6/14 have toilets, and these are useable in the wet season. 8/14 defecate far from the house in the dry season and do not bury feces. Feces close to house are buried. 13/14 women used menstrual pads and bury them after use. 5 kms: 20 mins in dry season, up to 1 hr in wet. When defecating near house feces are buried. house feces are buried Page 87

93 a) Village Information Kampong Chhnang Province, Baribou District, Punley Commune Svay Koy Village General Svay Koy is located close to the Punley Market. This village is floods seasonally, meaning that it floods for varying amounts of time during the wet season, but is dry in the dry season. The ground water table is close to the surface throughout the wet season. The better off households derive their income from rice farming and fish trading, while the poorer families produce palm sugar and grow vegetables, as well as farming rice. Daily income was reported as 10,000 KHR per day by the women s group; 4,000 by the rich/middle group, and KHR per day by the poor group. None of the focus groups reported any surplus income. Existing Watsan facilities Svay Koy village has a large reported number of toilets (village head) compared to other target villages in the same district. A total of 230 out of 315 (73%) households have their own toilets. This may be because of this village is located not far from town. However only 8/30 (27%) of respondents claimed they had a toilet. However, there were few water sources (wells) in the village, it was reported that there are four wells equipped with hand pumps. Three of these four wells are nonfunctioning. About 70% of HHs have their own dug wells, which produce water inconsistently. In the FGDs all groups said that water supply is their highest priority. An NGO (HAGAR) has provided 132 water filters (42% of households) to villagers for a KHR 40,000 contribution. Several HHs have purchased Rabbit Water Filters (designed by Red Cross of Cambodia). HAGAR also provided 7 latrines to villagers. Each latrine came with 4 concrete rings, a toilet pan and some flooring materials. The beneficiaries installed the toilets themselves. Awareness The members of this village seem to have a good theoretical understanding of safe hygiene and sanitary practices. It was noted that the NGO HAGAR had carried out awareness activities in the village recently as an adjunct to supplying the water filters mentioned above. However, the reported rate of hand washing after defecation was low at 10/32 (31%). Community Proposals 1. More latrines (pour flush) 2. More wells (open wells are preferred to boreholes) Page 88

94 Chheung Khnar Village General Chheung Khnar village is another village of Punley commune located close to Punley town. The living standard of villagers is higher than surrounding villages, the income of middle/rich families being approximately KHR 8,000 and of poor families around KHR 4,000 per day. Occupations of rich and middle households include fish farming, vegetable production, owning taxis and rice production, and of poor families providing labor and fishing. The level of understanding of sanitation issues is comparatively high. Ground water is easily accessible. Existing Watsan facilities There are many open wells in the village, but only 4 wells with hand pumps due to the high cost. Most families have been able to dig one open well for their own use. The four wells with hand pumps were provided by development programs some time ago. Most of the wells provide an acceptable water quality for villagers. Some wells provide iron-contaminated water, which is potable when using the water filter. Recently, the NGO HAGAR provided 48 water filters to villagers. Each beneficiary of this project is required to pay KHR 16,000 for the filter which they have to install themselves. The installation is followed up and checked by technicians from HAGAR. In this village there are 77 pour flush toilets and 5 dry toilets. Awareness People seem to be well aware of water and sanitation issues. Community Proposals 1. health post in or near village 2. water filters for all families 3. one well for each family Page 89

95 Kampong Chhnang Province, Baribou District, Khon Rang Commune Kampong Our Village General Kampong Our is a floating village located on the Tonlé Sap river. It is separated from other villages in Khon Rang commune and 7 km from Punley town. Having seen the floating water filter supplied to a nearby village, the community members want to have a similar system. The main thing that people wish to have is water filter. It is true that people can find water easily (living on water), but the water quality is poor. There was no discernable difference in sanitation behavior between rich/middle group and poor group. Women s group reported that in the dry season people usually defecate on land, and do not wash hands when doing so. Average incomes ranged from KHR 15,000/ day (reported by women s group) through 7,000 for rich/middle group and KHR 5,000 for the poor group. However the middle income group reported a surplus of $250 - $370 per year, so the reported average daily income for this group might be higher than the reported KHR 7,000. This group, together with village leadership, reported willingness to pay for a water filtration system, but not for improved sanitation. The other groups reported no surplus to spend on improved sanitation facilities. Villagers seem not to have any difficulty about feces disposal; dropping directly to the water is a practical and easy way. Results from a test carried out by an NGO, the rates of bacteria between samples (water) taken around where people defecate and ones taken from where people get water to cook/drink are substantially different; varying from very high where people defecate, to low for the ones taken from cooking/drinking supply area. Regardless, this village still suffers from reported high rates of diarrheal disease. Existing Watsan facilities There are no facilities in this village. Water from the lake is turbid; people commonly use alum to clear it. Awareness There is substantial awareness that the lake water should be treated before drinking for improved health. Community Proposals Floating filter house 18 as seen in a neighboring village. The water filter which HAGAR provided to the previous target villages is too heavy at around (a reported) 300Kg for floating communities. All community members want an appropriate water filter. Serey Village General 18 Floating filter house: it is a complete water treatment plant which consists of a water treatment system, pump, generator. The units are installed in a floating house. This complete unit is provided by an ADB project to Ses Slab village of Chhnok Trou commune, Baribou district, Kampong Chhnang province at a cost of 18,000$. The team sought further information from ADB in Phnom Penh but was unable to establish contact. Page 90

96 Serey village is located around 2km from Punley town. The overall condition of this village is worse than others in this group. Participants did not display evidence of recent bathing or clothes washing. Village surrounds were unkempt. The living condition of most people depends on rice production; however their rice fields are very small. As a result of this poverty children rarely go to school; their parents cannot afford school fees and children need to find work to support their family. The commune council intends to improve the living condition of villagers by providing people with work. Their solution is to get sons and daughters in each family trained for some skills, such as motor-bike mechanics. Existing WatSan facilities There are 145 wells 3 of which have hand pumps. Some wells provide water with high levels of iron and calcite, and a bad smell. According to the village leadership, 35% of households have their own toilets (pour flush). However only 2/26 focus group members had toilets, much lower than expected from the village official statistics. Awareness Participants in the meetings seem to have a low awareness of sanitation issues. The enumerators had difficulty getting the information sought as the participants seemed unfamiliar with the issues discussed. Community Proposals Participants did not place a high priority on sanitation issues. Even water supply issues had lower priority than employment, food and education Page 91

97 Kampong Chhnang Province, Baribou District, Melum Commune Melum Village General The group members reported incomes of 7,000 KRH/day for middle/wealthy group, 10,000/day for women s group, and / day for the poor group. The members of the poor group mainly sell their labour and have no surplus. The middle and women s groups reported some surplus from their rice and vegetable growing activities. Existing Watsan facilities In the opinion of the community in Melum the village has been well supplied with sanitation facilities by the NGOs World Vision, HAGAR, PRASAC program (EU) and ADB project. These NGOs have tried to interest people in Watsan facilities such as pour flush toilets with community participation of money and labor and some wells. As a result, according to the community, this village contains more latrines than other target villages in Kampong Chhnang province. However, from the data gathered, toilet coverage in this village is only 14%, and of the 6 villages in Kampong Chhnang Province only one (Kampong Our) has a lower toilet coverage than Melum. Community Proposals Neither villagers nor village leaders are interested in Watsan projects anymore, but instead they wish to have a water system for irrigating their crops in early or late wet season and also in dry season. They wish to have other infrastructure such as small bridges, culverts and earth road improvement to facilitate movement around the village, especially for kids going to school. Page 92

98 Toul Thlork Village General The living condition of villagers in Toul Thlork village is similar to that in Melum village (these two villages belong to the same commune). It is a small village, with only 58 households. The village is located close to the Tonle Sap Lake, and it usually floods once every several years. The ground water level is also high. Reported incomes varied from 5,000 KHR to 7,000 KHR per day. At 7,000 per day group members reported a small surplus. Existing WatSan facilities 76% of these household have their own latrines (most of them provided from World Vision and PRASAC program of EU). Around 70% of households have their own hand pump wells or open wells. It was reported that a number of these facilities were difficult to use during the wet season. Awareness People seem to have a basic awareness about hygiene and sanitation, but improvements in sanitation have a lower priority than irrigation and other income earning measures. Community Proposals The village leader wants the entire village to be trained about using water filters and clean water to prevent diseases. Need more wells because some wells don t have water in the dry season. Women s group wants more information and leadership on sanitation. Page 93

99 6.2. Lower Mekong River Floodplain Kamchay Mear District, Prey Veng Province a) Maps Map 13: Selected Study Villages, Kamchay Mear District, Prey Veng Province Page 94

100 b) Tables Table 36: Kamchay Mear District General Summary Kamchay Mear Total population HH Poor % with sanitation 30% District (Women = 52.88%, Men= 47.12%) No. Poor villages HH Ave % with sanitation 30% No Total villages 129 HH Better off % with sanitation 40% Current Watsan situation/issues Water: 70% of HH have installed their own wells (hand pump wells or ring well). The problem is that nearly all wells are not constructed correctly. As result, Most of the wells in the district provide water contaminated with iron compounds and with bad or muddy smell. Water is often turbid. Sanitation: Very few latrines were found in Kamchay Mear District (1.5%). People seem not to be aware Current Watsan programs Future plans for Watsan of sanitation issues. They typically defecate around their house. There was to be a project providing latrines in 2010 but it has been delayed. The village and district made the following suggestions (note: these are contrary to current MRD policy and CLTS methodology): Providing Latrines to villagers. Test water quality of existing wells and improve. Page 95

101 Table 37: Kamchay Mear District Surveyed Village Characteristics Village Data Tboung Prey Toul Prey Tres Chhour Trapeang Laak Trapeang Toul Wat Thnal Romeas Skun Kralagn Totals Ave Population HHs Male Nd % Female Nd % Under Nd Nd % % HH with toilets % Hand washing middle/rich 0/15 0/12 5/10 3/12 3/17 0/13 0/10 5/12 economic level % Poor level hand wash 5/12 1/12 4/12 5/12 10/10 12/12 3/12 7/ % Women hand wash 5/10 1/10 14/17 10/12 9/10 8/10 3/11 4/ % Table 38: Kamchay Mear District Surveyed Village Sanitation Behaviour Village Tboung Wat Prey Toul Prey Tres Chhour Thnal Trapeang Romeas Laak Trapeang Skun Toul Kralagn Middle/ 0/15 toilets. 0/12 toilets. 0/10 toilets. 0/12 toilets. Leaves, 3/17 toilets. 0/13 toilets. 0/10 toilets. 0/12 toilets. Children Rich Use leaves, Leaves, earth for Leaves, earth for earth for cleansing. Leaves, earth for Cleansing with Defecate in rice defecate around house, Economic earth for cleansing. Bury cleansing. Bury Bury children s cleansing. Bury earth and many field do not bury. do not bury. Adults in Level cleansing. children s feces children s feces feces near house if children s feces types of plant Children s feces forest, do not bury. HHs near house if near house if they they see it. Defecate near house if they material. 3/13 used not buried. Some Use tree leaves for they see it. see it. Defecate in in forest or near see it. Defecate in water filters. parents wash anal cleansing. Defecate in forest or near house. 9/12 use forest or near Defecate in forest, children s anuses forest or near house. leaves for cleansing, house. 9/17 use rice-field or near after defecation. house. 3 use water. leaves for cleansing, 3 use water. house in wet season. 1/10 cleanse with water, 9/10 use leaves and rice Poor 0/12 toilets. Economic 5/12 wash Level hands. 0/12 toilets. 0/12 toilets. Leaves, earth for Leaves, earth for cleansing. Bury cleansing. Bury 0/12 toilets. Leaves, earth for cleansing. Bury children s 0/10 toilets. Use leaves for cleansing. 10/10 0/12 toilets. Defecate in forest (dry season) or husks. 0/12 toilets. Defecate in forest (dry season) or 0/7 toilets. Defecate in fields behind house, and bury. Parents wash Page 96

102 HHs Women s group Travel time to health centre Handling of feces 0 toilets. 50% wash hands. Defecate near home (bury) or in forest (not buried) 80% use menstrual pads and bury or burn after use, 20% use cloths. 2 kms - 30 mins Chickens, flies, dogs, pigs clean up children s feces near house if they see it. Defecate in forest or near house. 0/10 toilets. Leaves, earth for cleansing. Bury children s feces near house if they see it. Defecate in forest or near house. 11/12 use menstrual pads and bury. About 205 of children s feces buried. children s feces feces near house if near house if they they see it. Defecate see it. Defecate in in forest or near forest or near house. 0/17 toilets. Leaves, earth for cleansing. Bury children s feces near house if they see it. Defecate in forest or near house. 80% women wash hands but only 20% men (reported by women). 5/17 use menstrual pads, 12/17 use clothes and wash. house. 7/12 use leaves, paper, earth for cleansing, 5/12 use water. 0/12 toilets. 80% bury feces. 60% bury children s feces. 4/12 use menstrual pads and bury. 8/12 use cloths, underwear. reported washing hands after defecation. 1/10 toilets. 8/10 use menstrual pads and bury.. Defecate in forest or near house. around house (wet season). Some is buried in wet season but much is cleaned away by the rain. 0/10 toilets. Defecate in ricefield forest or around house. Most feces buried around house, some washed away by rain in wet season. 3/10 use menstrual pads and bury or throw away far from house. 7/10 uses cloths, underclothes. Children defecate around house and 50% of this is buried. around house (wet season). Some is buried in wet season but much is cleaned away by the rain. 0/11 toilets. Defecate in ricefield forest or around house. Most feces buried around house, children s anuses with water (no soap) after defecation. Children s feces will be washed away by rain in wet season, buried in dry season. 0/11 toilets. Dry season defecate in forest, do not bury. Wet season near house 90% bury. 4/11 use menstrual some washed away pads, bury. 7/11 use by rain in wet underwear and cloths. season. 7/11 use Tree leaves used for menstrual pads and anal cleansing, some bury. 4/11 use use water. underwear and wash it frequently. 2kms 10 mins 1.2 kms 5 mins. 2kms 30 mins 1km 5 mins 7kms 30 mins 7 kms 30 min s 12 kms 30 mins Chickens, flies, dogs, pigs clean up feces, buried Chickens, flies, dogs, pigs clean up feces, buried if Leaves, earth for cleansing. Bury children s feces near Leaves, earth for cleansing. Bury children s feces Chickens, ducks, flies, dogs, pigs clean up feces, Chickens, ducks, flies, dogs, pigs clean up feces, Chickens, ducks, flies, dogs, pigs clean up feces, most is buried if Page 97

103 feces, buried if near house. if near house. near house. house if they see it. Defecate in forest or near house. 9/12 use leaves for cleansing, 3 use water. near house if they see it. Defecate in forest or near house. 95% bury feces in wet season and 60% in dry season. most is buried if near house. In plantation about 50% buried. most is buried if near house. In plantation about 50% buried. Much is washed away by rain in wet season. near house (wet season), the rest washed away. Page 98

104 Prey Veng Province, Kamchay Mear District, Krabau Commune Tboung Wat Village General Tboung Wat is a comparatively wealthy village where 60% of the population was regarded as rich by the village leadership. Another 30% was rated middle income with only 10% classified as poor. Both middle and women s groups reported average daily income of KHR 5,000, with occupations including traders, school teacher, soldiers, and rice farmers. Many families received some remittance income from members working in garment factories, and only the poor group sold their labor to potato and rubber plantations. No-one admitted to any surplus income. Existing WatSan facilities All target villages in Prey Veng province contain a lot of wells; most of them are local hand pump (VN 6 model) wells. There are 228 local hand pump wells, and 3 ring wells. Nearly all hand pump wells were provided by the family (families hire a local contractor to drill wells for them). The level of hygiene/sanitation awareness is not clear from the survey, but because it is in flood plain area, the ground water table is high in every season, so it is not difficult to get water. They drill around 10 wells every dry season; and the village has an adequate water capacity. Nearly all wells are not the standardized well, and some wells are dug by hand. The average cost is around 85$ for one well, including drilling fee and installation material and labor. People are reluctant to ask for water at other people s houses, so most of them have their own wells. Very few families have latrines; only 9 of 324 families own pour flush toilets. The latrine cost is not too expensive compared to the cost of a well, but people do not seem interested in having one. People prefer to have the freedom to defecate everywhere, in the forest around their house or in the rice fields. Awareness Water from most of the wells smells of mud or like water from the rice field, and people are keen to find a solution to this problem. Overall, most people in the village show a low level of awareness of hygiene and sanitation. Community Proposals 9 out of 11 people in the women s group want water filters. 2 out of 11 people need hand pump wells. 10 out of 11 people need latrines. Page 99

105 Prey Toul Thmei Village General The living standard is quite similar to that in Thboung Wat village. Village is located along the principal road (ASEAN road). Housing standard is quite high. Occupations included raising pigs, rice farming, trading, wood collection and sale for the rich and middle groups, and basket making and sale of labor for the poor group. Women s group reported a daily income of KHR 5,000, with no surplus. Existing WatSan facilities Nearly all families (235 HHs) have their own wells, most of them are local hand pump wells, and there are 13 ring wells. Most of the open wells give poor quality water. Only 9 households have latrines. Water from most of hand-pump wells contains iron. Pump wells can provide unclear water (high turbidity). When using water from pump wells to cook, rice can become colorful, (black or violet) Awareness People seem not to be aware about sanitation. Very few families boil water before drinking. The main health problems that the people meet are diarrhea, dengue fever (kids), fever, cold, typhoid fever and stomach ache. Community Proposals Need to have latrine (pour flush) for their villagers Need to have the good quality wells because most of the existing wells do not provide acceptable water. Some group members asked for more information on sanitation issues. Page 100

106 Prey Tres Village General Incomes reported by women s and rich/middle group ranged from KHR 5,000 to 4,000, with the poor group reporting less. Occupations included growing rice and cassava, and receiving remittance income from children working in garment factories in Phnom Penh. No groups reported any surplus income. Existing WatSan facilities This village has no latrines. There are 37 hand pump wells which produce water contaminated with iron. The quality of water from 12 lined wells is far superior to that of the wells with hand pumps. Awareness People rarely boil water before drinking. Community Proposals Community needs more ring wells, as they are easy to use, and require less maintenance than hand-pump wells. Latrine : pour flush latrines Some interest shown in trialing bio-gas systems Many families are interested in water filters Page 101

107 Prey Veng Province, Kamchay Mear District, Cheas Commune Chhour Thnal Village General Overall, the living standards and Watsan features in this village are quite similar to the previous villages. This village floods nearly every year. The water table in the village is around 0.7m. Village leadership reported that most families in their village are rich, but from the survey team observation, there was little difference between this and other villages in this district. Occupations reported were basket weaving, remittance incomes from family members working in Phnom Penh (mainly garment factories), and, for some members of the poor group, playing in a traditional orchestra. Incomes were reported around KHR 5,000/day for the middle and women s groups, and no-one reported any surplus. Existing WatSan facilities There are 37 local hand pump wells and 22 lined open wells, but no latrines. All hand pump wells are used in the full year, but some of open dry up in the dry season. Awareness People seem not to be aware about sanitation; most families drink unboiled water. Community Proposals Need more wells, Latrines, Water system for irrigation 80% of people wish to have latrines 20% of people would prefer a water filter over a latrine. Page 102

108 Trapeang Romeas Village General Living conditions seemed similar to previous villages. Reported occupations were remittance incomes, pig and cattle raising and rice farming for the rich and middle groups, and rice farming and laboring in cassava and rubber plantations for the poor. Existing WatSan facilities 10 of the 52 hand pump wells provide water with a lot of iron rust (when left for 1 day). There are 2 lined wells, which are dry in the dry season, and two mixed wells (lined well with hand-pump). Awareness People seem not to be aware about sanitation; most families drink unboiled water. Community Proposals Wish to have more wells in the village, for each family, especially for poor people. Pour flush latrines Water filters. Page 103

109 Prey Veng Province, Kamchay Mear District, Smoung Chheung Commune Laak Village General Several NGOs are active in this village: Agronome et Vétérinaires sans frontière. (AVSF) Canadian International Development Agency (CIDA) World Food Program (WFP) Occupations include rice farming pig raising and trade for the rich inhabitants; rice farming, remittances, palm sugar production and construction labor for the middle group, and general labor, palm sugar production for the poor. All groups receive some remittances from children working in garment factories. Women s group income was reported at KHR8,000 per day and middle/rich group at 6,000 per day. This village always floods in the rainy season, and culverts are needed across the main road to reduce the flooding. Existing WatSan facilities There are 26 wells with hand pumps, all of which provide iron-contaminated water, with a brackish or briny taste and a bad smell. Awareness People seem not to be aware about sanitation; most families drink unboiled water. Community Proposals latrines, Better quality water Information about sanitation issues Page 104

110 Trapeang Skun Village General Occupations listed for this village: rich rice farming, trade; middle: palm sugar production, rice farming, construction labor, remittances; poor group palm sugar production, construction and rubber plantation labor. The middle/rich focus group earned KHR 8,000 per day, and had a surplus of around 100,000 to 200,000 per year. This was the only report of surplus income for the villages surveyed in this province. Women s group reported 7,000 per day income. Existing Watsan facilities Most hand pump wells provide rusty water (it gives a black color to food when using this water to cook) Awareness About 20% of those surveyed routinely boil water before drinking. Awareness of water and sanitation issues is low-medium. People want to have more information about these issues Community Proposals A majority of people surveyed wanted to have latrines (pour-flush) and 50% were willing to participate financially in construction, up to around KHR 20,000. Many people also want to have water filters or a potable water supply. Page 105

111 Toul Kralagn Village General The middle income group mainly farms rice, and receives remittances from daughters working in garment factories. The poor group members raise chickens, farm rice, and provide their labor wherever it is needed. Existing WatSan facilities 16 hand pump wells, 2 lined wells. 38 HHs have water filters, 2 home-made and the rest provided by an NGO. Most hand pump wells provide acceptable water. Awareness A few households boil water before drinking, but this is far from the norm. Community Proposals The groups expressed their wish to have: Water filters Pour-flush latrines Community participation in facilities construction is guaranteed, but there are no surplus funds for cash contributions. Page 106

112 6.3. Lowland Old Alluvium with High Groundwater Table and Drought Basedth District, Kampong Speu Province a) Maps Map 14: Selected Study Villages, Basedth District, Kampong Speu Province Page 107