In Bhutan, the Ministry of Health and SNV Bhutan have partnered together to develop the Sustainable Sanitation and Hygiene for All Program as part of the Ministry of Health’s Rural Sanitation and Hygiene Program (RSAHP). This program seeks to achieve access to sustainable sanitation and hygiene practices for 35,000 people, without external subsidy, and is based on concepts of community-led action and appreciative inquiry. The program is based on a comprehensive approach involving: »sanitation demand creation met with supply chain development; »behaviour change communication; and »inclusive governance.1In the remote district-wide program area of Lhuentse in Eastern Bhutan, performance monitoring data in 2011 showed that, hile access to improved sanitation had increased from 27 per cent to 86 per cent in the past year, there were still a number of households that remained without access (Figure 1). As a district, Lhuentse has some of the highest poverty levels in Bhutan with 43 per cent of households reported as living in poverty.2 With a focus on inclusion and the objective of achieving district-wide universal access to sustainable sanitation and hygiene, the program sought to understand more about existing local pro-poor support mechanisms, which might be mobilised within communities in the program area. This program also aimed to understand specific difficulties householdsere facing in meeting their sanitation aspirations, beyond financial limitations.
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