The Partial Usage of Toilets

Reposted from Institute of Development Studies website.

18 February 2016

The partial usage of toilets is a frontier subject for Community-Led Total Sanitation as well as the broader sanitation sector. Some members of a household may not use a toilet at all, while others may only use it some of the time. Some people may only use toilets during the rainy season when open defecation becomes more difficult and uncomfortable.

Partial usage of toilets both prevents and threatens open defecation free (ODF) status of communities. It is something we explore in Norms, Knowledge and Usagethe latest in the CLTS Knowledge Hubs Frontiers of CLTS: Innovations and Insights series.

The word frontier is appropriate as it is something not well researched or documented and consequently we know very little about it. Most of the evidence comes from India where the Swachh Bharat Abhiyan (Clean India Mission), a large scale government sanitation programme, is currently underway. However, India is also where most of the research has been conducted and we cannot assume that this does not happen in other parts of the world – studies in Ethiopia have shown similar results. Yet, it presents some very serious challenges ahead in order to achieve and clean and open defecation free India.

Why does partial use happen?

We have identified different factors associated with partial usage which are:

  • Social norms
  • Taboos, beliefs and prohibitions
  • Preferences and convenience
  • Age and disability
  • Gender and gender relations
  • Pressure on use
  • Full pits and fear of pits filling up
  • Dirt, smell, disgust, fears and cleaning
  • Design, construction and ownership

These factors may work in isolation but it is more likely a combination of these is to blame. Social norms and social pressures can be different for different members within a household which can be due to age, gender or disability. For example a study in Bangladesh found that elderly members continued to openly defecate despite others stopping were not severely criticised. Men may practice openly defecation when toilets are in high demand as it is more socially acceptable for a man than a woman.

So what?

Despite this being a new and emerging topic there are still preliminary conclusions that can be drawn:

  • Any intervention attempting to change social norms must make sure that open defecation by all community members, including men and the elderly, becomes socially unacceptable. Campaigns that focus on particular groups within a community run the risk of others who do not identify with messages continuing to defecate in the open.
  • This establishment of new and consistent social norms needs to be coupled with technologies that are accessible and affordable as well as socially and culturally acceptable for all. These will vary and will be dependent on physical and social context. Acceptability and affordability of maintenance and safe sludge and pit management options must also be considered.
  • Finally, this topic is something that should be given priority for rapid action research. Is this predominantly an Indian problem or does it challenge the sustainability of ODF communities in other countries?

We are in the early stages of exploring and learning about this and invite comment, criticism, correction and further insights on the work we have untaken so far.

WASHplus Year Five Annual Report, October 2015

WASHplus Year 5 Annual Report.png

In its Year Five Annual Report, WASHplus has stories to tell, results to share, events to celebrate, and studies that add to the evidence base. WASHplus activities serve as the backdrop for many stories: the Zambian school girl who has access to privacy and menstrual supplies when she needs them, the Malian household that can now build an improved latrine on their rocky soil, the mother in Bangladesh who understands the importance of a feces-free environment, the Nepali home breathing cleaner air as it trials an improved cookstove. And perhaps more compelling than the individual stories are the results the project is beginning to record through endline data collection in Kenya and formative research on school enrollment and in Zambia. Providing water, sanitation, and hygiene (WASH) infrastructure to schools is having a notable impact on enrollment. Community-led total sanitation (CLTS) may be inoculating communities exposed to cholera. Numbers also tell the story of the project’s impact. Look for a snapshot of those figures throughout the report.

The conclusion of field activities in Uganda and Zambia this year provided opportunities to reflect, celebrate accomplishments through end-of-project (EOP) events, and share lessons learned. Several articles were published this year in peer-reviewed journals and others submitted on topics ranging from consumer preferences and willingness to pay for improved cookstoves to habit formation and costing of handwashing. WASHplus also played a key role in preparing the joint document on WASH and nutrition for publication and distribution.

WASHplus’s focus on integrating WASH into other development initiatives enabled the project to get in on the ground floor on subjects that are gaining traction at USAID and globally, such as WASH and nutrition, neglected tropical diseases, and MHM. This integration focus dovetailed nicely with the project’s mandate to serve a technical leadership role, and project staff had many opportunities this year to share its work and lessons from the field on a global stage, strategize with partners on important advocacy issues, inform policy, and develop guidance in multiple countries. Also toward that end, WASHplus launched its first two learning briefs on small doable actions and WASH and nutrition. This series details the variety of approaches WASHplus uses to improve WASH and household air pollution (HAP) across its portfolio of countries.

And finally, it’s been an exciting year for innovation with pilot projects underway in Ethiopia and Bangladesh focusing on sanitation marketing and sand envelopment. These two efforts will add to WASHplus’s body of knowledge on sanitation innovation and aligns closely with USAID’s global interest on the topic. WASHplus is also documenting its fecal sludge management work in Madagascar to tell the next chapter in that story.

Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time

WASHplus’s Julia Rosenbaum co-presented a paper on “Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time” at SACOSAN 6 in Dhaka in January 2016. An abstract for the paper is provide below. Read the paper here.

Abstract: The global USAID WASHplus Project successfully increased access to water, sanitation and hygiene by applying a comprehensive and innovative approach in hard-to-reach areas of southwest Bangladesh. Rather than promoting ideal water, sanitation and hygiene (WASH) infrastructure and behavioral improvements, households were encouraged to take ‘small doable actions’ – feasible yet effective improvements – that moved toward the ideal practice. Through taking this approach, the project met and surpassed all project targets before the end of the project period. Project implementers worked with community members to develop age-specific behaviors for safely disposing infant and child feces and also for patching leaky latrines that dump feces back into the environment.

Citation: Rosenbaum, Hussain, Ferdous, and Islam, January 2016, Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time, FHI 360/Bangladesh, WASHplus Project, WaterAid/Bangladesh,  SACOSAN 6, Dhaka, Bangladesh.

 

When ODF is Not Enough: Presentatgion on at SACOSAN 6

When ODF is Not Enough: Using a Small Doable Actions Approach to Complement CLTS
and Get Faeces out of the Environment in Southwest Bangladesh,” Presentation by Julia Rosenbaum, Khairul Islam, Muhammad Faruqe Hussain, and Selina Ferdous, SACOSAN 6, January 2016, Dhaka, Bangladesh. See the presentation slides here.

Rosenbaum_Sacosan 6_PPT.png

See the presentation slides here.

Sanitation and nutrition: Let’s break the vicious circle!

This short, educational, animated video from Generation Nutrition explores the links between sanitation and nutrition. The video has been translated into English with funding from the USAID WASHplus project.

WASHplus is working on integrating WASH and Nutrition programming not only by improving water, sanitation and hygiene (WASH) in places where we work but also by working towards a fuller integration of WASH, health and nutrition programming. Learn more about WASHplus’s work in WASH-Nutrition Integration.

 

Bangladesh—Sending Poo to its Final Address

Bangladesh_Poster_What to do with Infant Poo_WASHplus

WASHplus continued pioneering work developing a menu of small doable actions for the safe disposal of infant feces. Working with program partners, the project team further refined doable behaviors for four cohorts of infant and young children, and worked with designers to develop a set of job aids to integrate Essential WASH Actions into Feed the Future nutrition implementing partner work. The materials all work around the theme “Poo’s Final Address,” highlighting that whether the child defecates in the courtyard, potty, or infant wrapper cloth, the poo needs to end up in the family latrine. This poster provides an overview of the WASHplus approach to infant feces disposal along with examples of small doable actions for several age groups.

Download the poster here.

 

The usefulness of a handwashing proxy in large household surveys

WASHplus’s Monitoring, Evaluation, Research, and Learning Advisor, Orlando Hernandez, co-authored a paper on the usefulness of a handwashing proxy in large household surveys. An abstract of the paper is provided below.

“Handwashing with soap is a cost-effective way of reducing diarrheal disease mortality in children under 5. Tracking this practice among child caretakers is a challenge, as the gold standard method – structured observations – is cumbersome, costly, and conducive to over-performance. The water, sanitation, and hygiene (WASH) field needs a valid, reliable proxy to track handwashing with soap in large surveys. This proxy is crucial as the new 2015–2030 Sustainable Development Goals (SDGs) may track hygiene. Using data from the Multiple Indicators Cluster Survey (MICS) and the Demographic Health Survey (DHS) from five countries, we conducted multivariate analyses to explore an association between the presence of functional handwashing stations (HWSs), (together with needed supplies) and the likelihood of lower reports of child diarrheal disease. A limited to moderate association exists in three of the five countries considered characterized by comparable rates of childhood diarrhea: Malawi, Sierra Leone, and Zimbabwe. The relationship was detected when controlling for potential confounding factors (other WASH elements, socio-demographic factors, nutrition practices, and immunization status) and when accounting for cluster effects. The likelihood of reported diarrhea among children under 5 increases when there is no HWS, just a handwashing device with no supplies or only water or only soap. The relationship is moderate in Malawi and less strong in Sierra Leone and Zimbabwe. No relationship was found in Ethiopia and Ghana. Further exploration of the usefulness of this proxy in other African and non-African contexts is warranted.”

Read the paper here.

Citation: Victoria Shelus and Orlando L. Hernandez, The usefulness of a handwashing proxy in large household surveys, Available Online 20 August 2015, DOI: 10.2166/washdev.2015.184

 

 

WASHplus Presents at ETHOS 2016 Conference

The 2016 ETHOS Conference was held in Kirkland, Washington from Friday January 29th – Sunday January 31st, 2016. The conference aims to expand its reach from previous annual meetings, encouraging participation of Southern partners, international stoves experts, and development specialists with field experience in the transfer of cooking technologies.

At the ETHOS conference this year, WASHplus’s Household Energy Specialist Elisa Derby presented on the results of two consumer research studies on improved cookstoves in Bangladesh and Nepal, and the Cookstove Consumer Research Toolkit which is currently under development.

See the presentation here.

Derby ETHOS image

 

Galvanizing Schools to Take Action in Benin

benin school kids

Over the past few months, WASHplus through implementing partner ABMS/PSI has stepped up advocacy for latrine improvement in several public schools in Benin.  One school, with a student population of 1,500, has four latrine blocks that are unusable because they are full.  Even though WASHplus/ABMS and school officials successfully lobbied the Ministry of Education for a USD $200 line item for pit emptying, the urgency of the situation prompted the PTA to front the money and hire a pit empying service soon thereafter. The head of the PTA explained that joint meetings called by WASHplus/ABMS field staff to bring the group of teachers, the school director, and PTA members to the actual site of the latrine blocks and expose them to the extreme contamination “Woke us up.” WASHplus is supporting development of a sustainable usage and maintenance plan along with installation of handwashing facilities and possible additional latrine construction. Read the full story here.

 

 

 

Voices from Bangladesh: Reflections on SACOSAN VI

Reblogged from PPPHW blog.

julia rosenbaumBy Julia Rosenbaum, Senior Behavior Change Advisor USAID/WASHplus Project

I recently attended the 6th South Asian Conference on Sanitation (SACOSAN VI), held in Dhaka, Bangladesh. Given the clear ties between sanitation and hygiene, I was asked to provide commentary on the prevalence and discussion around hygiene at SACOSAN. A commentary on hygiene, however, first begs the question, “What is hygiene?”, as it means many things to many sacosanpeople. To some, hygiene pertains exclusively to handwashing with soap. To others, it includes food hygiene and treatment and safe storage of household water. To others, still, it means any “software” or promotional aspect of within water, sanitation, and hygiene (WASH) generally, such as behavior change. It is fair to generalize that hygiene was comprehensively defined at SACOSAN including the “software” side of WASH, specifically regarding sanitation, handwashing, and menstrual hygiene management.

A major theme throughout the conference was a renewed call for representation and inclusion through the human right to sanitation. This was true in terms of hygiene, too.

Representation and inclusion were perhaps best represented in a session that highlighted a new publication and spotlighted issues facing women, adolescent girls, the elderly, persons with disabilities, and those in the sanitation workforce. Leave No One Behind, a stunning new publication of Freshwater Action Network South Asia and the Water Supply and Sanitation Collaborative Council, seeks to give voice to those too often neglected and excluded from both political processes and access to sanitation and hygiene services. The objective of the publication and the initiative is to assure inclusion and representation, considered essential to achieving the newly agreed upon Sustainable Development Goals.

The session corresponding with the Leave No One Behind report illuminated the tremendous obstacles and humiliation suffered by these individuals and the corresponding consequences—including indignities, poorer health, and safety concerns. Yet, despite the many conversations about access, what was most poignant to me was the overall inaccessibility of the conference center despite efforts to find a more accessible venue. Clearly, in many contexts, access needs to be better ensured and not merely discussed. While the focus of this session was to highlight the “voices” of those featured in the report, there was a striking absence of positive examples and best practices that have been refined over the past decade and do provide access to many who might otherwise be left behind. Showcasing ways that access can be achieved—for instance, displays of simple latrine and handwashing station modifications to allow access to the differently abled, the elderly, the deaf, blind, and mute—or outlining inclusion strategies and approaches gaining prominence could have prompted session participants to not merely discuss the need for inclusion but also inspired action.

While I wish that the accessibility issues faced by participants had been addressed, there were many highlights of the conference. It was heartening to see participants spontaneously organize a special side session on menstrual hygiene management (MHM), as it was not prominently included in the program. Facilitated by WaterAid and featuring a wide range of panelists including government officials, global leaders, and community representatives, this lively session filled a gap and helped to prioritize menstrual hygiene management in the SACOSAN declaration and commitments.

The meeting’s hygiene promotion session was coordinated by the Afghani Delegation. The four technical papers that comprised this session—including one co-authored by USAID/WASHplus—comprehensively defined hygiene promotion. As a result, there was a large focus on sanitation best practice and innovation, such as improving sanitation and hygiene (mostly handwashing) practices in geographically-challenged areas, fostering strategies to improve sanitation coverage and developing approaches to improving sanitation practice (i.e., latrine use) and consistent and correct handwashing with soap. A forth session focused on MHM, and boldly shared the failures attributed to not thoroughly consulting with school girls and administration, as well as successes.

Hygiene was also prominent in a plenary session chaired by BBC Media Action (formerly BBC World Service Trust). Via a provocative video presentation, behavior change specialist Dr. Val Curtis with the London School of Hygiene and Tropical Medicine, highlighted three elements—surprise, revaluation, and performance—as fundamental and effective at improving WASH. This video was followed by prominent national journalists who discussed how to get the public to engage in topics considered unpleasant and often taboo by capturing audience attention and greater media visibility.

The linkages between sanitation and hygiene are clear, and it is encouraging that hygiene was featured prominently in the meeting’s Declaration and Commitments where every mention of sanitation included “… and hygiene”. I am hopeful that the calls for representation and inclusion of the vulnerable and underserved that were made during SACOSAN will lead to a truly enabling environment, and that we will learn from our oversights and collaborate going forward to improve access to sanitation and hygiene for all.