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Tampereen teknilllnen korkeakouluRakennustekniikan osastoVesi- ja ympäristöi:eknlikan laitos

Tampere University of TechnoiogyDepartment of Civil Engineerlnglnstitute of Water and Environmental Englneering

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Hukka, J.

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Environmental Sanitation - Beyond the Decade-Discusslon Paper

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FOREWORD

This is a discussion paper published inforiually bythe Talnpere University of Technology, Institute ofWater and Environmental Engineering (TtJT/IWEE).This paper is based almost exclusively on theliterature review, and it will be available onlyin English.

The focus of environiuental sanitation in thiscontext is on-site sanitation in the Third WorldCountries. Especially the experiences during theInternatJLonal Drinking Water Supply and SanitationDecade (]:DWSSD) 1981—90 are discusseð. Because theachievements regarding the sanitation servicecoverage and the use of the constru~ted facilitiesduring the Decade have been rather modest, theiinprovements will be required also in this sector,if the intended goal health for all by 2000 isto be met:.

This paper has been written particularly for thefurther development regarding the externallysupported community sanitation programmes. Thefinal draft of this paper has been distributed tothe part:icipants of the Finnish InternationalDevelopment Agency (FINNIDA) seminar onenvironmental hygiene improveinent on the 4th ofOctober ].989 in Espoo, Finland.

Finally, I wish to express my gratitute to thecolleagues in TUT and in FINNIDA, whose commentshave greatly improved this paper.

Tampere, 12 January 1990

Jarmo HukkaResearcher

ACKNOWLEDGEMENTS

This paper was initiated with financial supportfrom FirLnish International Development Agengy(FINNIDA). The support is gratefully acknowledged.

ENVIRONMENTALSANITATION - BEYONDTHE DECADE?

TABLE OF CONTENTS Page

FOREWORD

ACKNOWLEDGEMENTS

ABBREVIATIONS AND ACRONYMS 01

1. BACKGROUND O2

2. BENEFITS OF IMPROVED ENVIRONMENTAL SANITATION 05

3. PROVIDING SERVICES THAT PEOPLE ARE WILLING

TO PAY FOR 08

4. COUNTRY STRATEGY 11

5. LEGISLATION 14

6. CULTURALASPECTS 15

7. PROJECT PLANNING AND IMPLEMENTATION 17

7.1 Baseline Studies 207.2 Finance 217.3 Timeframe 227.4 Connnunity Involvement 227,5 Private Sector 247.6 Choice of Technology 257.7 Production and Construction of sanitation

Facilities 297.8 Usage and Maintenance of Sanitation

Facilities 317.9 Environmental Impact 327.10 Review and Evaluation 327.11 Education afld Motivation 357.,12 Training 397.13 Research 40

8 CONCLUSIONSAND RECONNENDATIONS 41

9. REFERENCES 50

RECOMMENDED BACKGROUND READING 61

1

ABBREVIATIONS AND ACRONYMS

BÀTBMZ

CARECIDADACDANIDAFINN I DAFRGGTZHIEHIRDEP

IDRCIDWSSD

IRCIvsMEPNGONORAD

NWSDBOECD

SEAROSIDAUNDPUNICEFUSÀID

USDvIPvWSSWASHWEDCWHAWHO

- Best Available Technology— Federal Ministry for Econo1nic Cooperation,

Federal Republic of Germany- Cc)operative for Ajnerican Relief Everywhere— Canadian International Development Agency— Development Assistance Committee- Danish international Development Agency— Finnish International Development Agency- Federal Republic of Germany- German Agency for Technical Cooperation- Health Impact Evaluation- Hambantota Integrated Rural Development

Programme— Iriternational Development Research Centre- Internatiorial Drinking Water Supply and

Sanitation Decade— Iriternational Reference Centre- Internatiorial Voluntary Service— Miniinuin Evaluation Procedure— Non—governmental Organization- Narwegian Ägency for Development

Ccoperation- NaLtional Water Supply anðDrainaqe Board— Organization for Economic Cooperation and

Deve1opment- WHORegional Office for South-East Asia— Swedish International Development Authority- United Nations Development Prograinine- United Nations Childrens Fund— United States Agency for International

Development- United States Dollars— Ventilated Improved Latrine- Vìllage Water Supply and Sanitation- Water and Sanitation for Health Project— Water, Engineering anð Developinent Centre- World Health Assembly- World Hea].th Organization

2

1 BACKGROUND

UMBAN

WATEM BUPØLY

Once upon a time, a inonkey and a fish werecaugrht up in a great flood. The iuonkey, agileand experienced, had the good fortune toscra,mble up a tree to safety. As he lookeddow]1 into the raging waters, he saw the fishstru.ggling against the swift currents. Filledwith the desire to help his less fortunatefellow—creature, he reacheð down and scoopedthe fish from water.

0.

00

~rri1~fl

1570 1175 1580 1950 1813R9VIOE9~

r ~ÍiÍi0

1570 I!75 1990 1980 b 813R9Vl000

SANITATION

94 ~

~ Yol~p~.0o. IX 10 .n1180.)P..j.ll.o .on...d 0 10 .dlRonl

Figure I. Water supply and sanitation. Globalcoverage in 1970, 1975, 1980 and 1983.(WHO 1986).

3

So]netiiues the achieveinents in the sanitationsector (Figure I) may resemble the story above,but the whole picture is somewhat different:

Accordinçr to Lewis (1989) the speed of healthiinprovements in the developing countries isunprecented in hu1nan history. For instance, ittook bet;ween 50 and 70 years to halve infantmortality rates in the West, yet the sameilnprovemant took only 25 years in the developingcouritries. Investiuents in education, water supply,sanitation and the control of tropical diseaseshave playeð a inajor role in this achievement.

Caldwell (1986, cited by ~ryant 1988) has exaininedthe characteristics of the exceptional progress inhealth development in soine couritrjes e.g. in CostaRica, in Sri LarLka, and in the State of Kerala inIndia. He states that unusual low mortality can beachieved ín the following conditions:

1. There is a reasonable level of feinaleeducation and sufficient female autonomy.

2. The society is of a kind that generates acontinuing political activity.

3. There is ready access to health services.

Nag (1988) also pointed out that although Keralahas lagged behind the other Indian states inindustrialization, incoiue, arid urbanization, ithas the lowest mortali,ty and fertility levels inIndia.

The message is quite clear: the iinproved healthconditions • are not necessarily economicdevelopinent spin-offs. The better health can beachieved, if appropriate measures are introducedand proinoted.

The objective of environmental sanitation shouldbe the overall iinr~rovement in the coinmunity~physical environinent (houses, yards, sanitationfacilities) to make the conditions more hygienic.

4

This could be done by proinoting improvement ofhealth a.nd community development (multisectoralapproach: health; agriculture; education; waterand sanitation~ housing; industry) not byproviding only physical infrpstructure (sectoralapproach).

5

2 BENEFITS OF IMPROVEDENVIRONMENTALSANITATION

Lewis (1989) stated that critical to improveinentsin health care is expanded investi~ient ininfrastructure clean water supply and sanitationare the inain areas where iinproveinent is needed inthe next century.

According to hiin cures for communicable diseasesare essential but inadequate, because they cannotprevent repeated infections. Most of the diseaseswhich prevail in developing countries when watersupply and sanitatiori are deficient are infectiousdiseases caused by bacteria, protozoa, viruses orworins.

Sanitation is an important intervention in diseasecontrol since the water and sanitatiori relateddisease causing organisms are present in excretaof infected persons. Proper exreta disposalinterrupts the cycle of disease transmission bypreventing humans, animals and insects coming ìntocontact with faeces and urine. This will reducethe possibilities of further transmission ofdisease (rable I).

Table I. Prevention of transmission of water andsanitation related diseases (van Wijk-Sijbesma 1985, adapted from WHO1983).

Discane Safc Safc Personal Safc Saíe winlewiter cxcrcta and hlndling watcr di~-

dispoul domeotlc of food pos*l andhypicnc driinagc

Diirrtioca ++ •4--l- ++ ++ —

Worm iflfcslaliofl~

roundworni + ++ + ++ +

whipworm + +-F -s- +-s- -s-plnworm + ++ ++ +

hookworm + ++ + —

guinci worm + + — +

ochisiosomias;s + + + — — +

Skin ind eyciníeciioai~.andlouse-bornemfeŒiofls — — + + — —

Mosquito and lly.bornc infections

malarii — — — — +

ydlow fcvcr/denguc — — +

liliriails — ++ — — ++

slceping sickneos — — — — —

nvcr blindness — — — — —

Adapied from WHO (732)

+ + — high+ medium— — low or nigligiblc

6

First, it is iinportant to bear in mind thathealth benefits are never the sole, andseldom the n~ajor, benefit of water supply andsanitation project (Briscoe et al 1986).

Okun (1987) described:

Water supply and sanitation provìdes manymore benefits, however, benefits that areessential to sustaìning the lives saved byOTR (oral rehycjration therapy) and vital tomaintaining and enhancing the lives of adultsand children. wS&S prevents the causes ofdiarrhea; controls many other water— andsanitation—related diseases; improves thedelivery of primary health care; improvesnutritional status; services health centersand schools; releases women from the heavyand time—consuming burden of carrying waterfroin distant sources; provides water forhousehold gardens and animals; proinotescommercial activity, supports other sectors,such as housing and industry; improvescominunity organizations that can serve otherpurposes; and, most significantly, improvesthe quality of life in the conununity.

According to Parker (1985) the inajor benefitsbased on his Botswana experiences were~ improvedhealth, privacy, convenience, status andprevention of measles in cattle.

Taboos arid other cultural constraints associatedwith the handlin•g of excreta may prevent the useof excreta for economic purposes, butenvironme:rital sanitation as an industry canprovide economic progress e.g. busiriessopportunities, jobs etc.

Although Edwards (1988) stated that effectiveinstitutional developinent projects are not commori,environmental sanitation programmes could also beused in strengthening ininistries, regiona].authorities, private enterprises or communitiesalike.

The private sector has not been very keen oninvestîng in the sanitation, but certainly taking

7

into account the huge inarkets for the improvedfacilities, it would be worthwhile to investigatethe possibilities of investinents and actions tomake this sector commercial and productive.

Sulabh Shauchalaya Sansthan is e.g. an Indian,though non—profit making organization provìdinglow-cost sanitation facilities on a cominercialbasis for hundreds of thousands who do not havetheir own facilities in large and sinall urbancentres (Vijayendra 1979).

8

3 PROVIDING SERVICES THAT PEOPLE ARE WILLING AND ABLE TOPAY FOR

Sanitatì()n differs from water supply, becausesanitation facilities are likely to be in inost ofthe cases more or less private instead of beingcoiiununity ìnanaged, i.e. facilities are more inrural areas an individual or fainily responsibilityrather than community responsibility.

People cLo want improved services, but only ifthese meet their perceived needs, users are ableand wil].ing to pay for the services that theyperceive valuable.

Briscoe et al (1988) described:

Rural people alìnost always want improvedwater supplies, but seldom want to itivest insanitation improvenients. A recent survey inZimbabwe showed that 26% of the women and 20%of men saw improved water supply as theirinost important develoment need. Althoughthere has been a relatively successful effortto iinprove excreta disposal facilities inrural areas of the country, less than 1% ofwon~en and no inen put. improved excretadis~ßa1 at the top of the list. There is,however, consistent evidence from Asia,Afrlca, and Latin Ainerica that if improvedexcreta disposal facilities are promoted inconjuction with a water supply program thatmeets the felt needs of the people, improvedlatrines will often be built and used.

People throughout the world have an array ofstrongly held beliefs about defecation, butwhere improved facilities are wanted, surveysiri India, !4alesia, Mexico, Zimbabwe, andother parts of the world show the principalperceived benefits to be privacy

.

conviniençe. and stptus--but not health. Itfollows that where population densities arerelatively low, demand tor iinprovedfacilities for excreta disposal is rarely ahigh priority.

9

According to Kamau (1983) 47% of the interviewedpeople felt that inadequate toilet facilities wasthe inajcr problein in !4athare Valley squattersettlemen,t in Nairobi, Kenya, and 90% felt thateven if it would have lead to increased cost forhousing, they preferred to have water-borne toiletfacilities connected to each plot.

People in Lesotho are rather investing in housing,furniture and farming than in a latrine(Dlangamandla 1985). Houses have a prioritybecause they can be rented out to provide someincome.

Analysis on Mozainbiques Improved LatrineProgranune shows that people living near productioncooperatives, having relatively high econoinicstatus and high educational level were more likelythan others buying iìnproved latrines (Muller1988).

There are evidences that even in the poorer partsof the developi.g world villagers have shown aconsiderable ability to pay in cash for theservices they wanted. They are also willing tomake contributions in ].abour anð cash if there isa clearly felt need for services.

In Ayadaw towriship, Burma funds were collectedfroin all the households in the selected villagesto cover certain costs such as cementtransportation (U Tin U et al 1988). These ìnodelvillages also contributed labour to collectconstruction materials from the supply depot. Thepans and squatting plates were distributed inaccordance with the availability of water anð theabilìty of families to pay for thein. In 1978 orilyabout 1O% of the population had access to propersanitation, and i.n 1985 about 90% respectively.

Finnwater (1986) recommended based on the reportby Wright (1984) that construction of latrinesshould ~tire1y be financed by the users in MtwaraRegion, Tanzania.

Kalbermatten et al (1987) stated that in Baldia,Karachi the people are paying for 90% of thecapital costs and all of operation and ìnaintenance

10

of pour—flush latrines.

Water supply improvements may be the necessaryfirst st.ep in stiinulating demand for bettersanitatiain, and sanitation focused hygieneeducation programmes in conjunction with ruralwater supply projects ìnay reinforce this effect.

Willingness to pay for sanitation services is muchmore problematic1 because willingness to pay forsuch services is generally low, except in high—income groups and densely populated areas. In mostcases coverage levels have been too low to achievesignificant health gains, and the heavy subsidies(as usual) have gone to the rich, not to the poor.

11

4 COUNTRY STRATEGY

Hurnan excreta disposal problems indeveloping countries cannot be solved withthe strategies presently favoured bygoverninents and aid agencies (Wiriblad 1987).

First, t:he strategy should be based on use ofpublic and private sector to create an environinentin which coxninunity management can functionsuccessfully. Secondly, it should be based onaffordable and sustainable technology.

The role of each sectoral agency or ministry inparticipa.ting in the improveinent of healthconditions should be developed to fulfill therequiremants of intersectoral cooperation.

Also the international agencies should developpolicies which cope better with the need ofintersect.oral cooperation in order to improvehealth status.

Due to the coinplexity of the relationship betweenwater supply, excreta disposal and health thestrategy for health improvement requiresdefinitely an intersectoral approach.

If the sanitation programmes having einphasis onthe technical and engineering components only arenot linked with the other sectors, it is likelythat the full capacity in environment and healthimprovement wil.1 not be utilized, and thesimultaneous effects of complementaryintersectoral development prograiuines will be lost.

However, in intersectoral programmes thecoordinatiori should be effective, because there isa danger that the community would be givenconfusing inforiuation from different parties.

To improve sanitation in rural areas, a latrineconstruction programme could be includeð inhousing programmes like in Million Housesproject iri Sri Lanka (Cotton et al 1987). In thisprogramiue the village-level community andindividual housaholders are responsible for the

12

provision of housing, with the Sri LankasNational Housing Authority assuining the supportiverole. The loans to the householders are providedon condition that a latrine is constructed if thehouse does not already have one. Part of the loaninay be uE;ed for the construction of the latrine.

Accordinci to Tennakoon (1988) the Department ofHealth in $ri Lanka offers subsidies and providessquattinçp plates and water—sealed porches asincentives for latrine construction.

Tillman et al (1988) proposed that improved watersupply arLd sanitation should become together withhealth eðucation and community participationconcept an integral part of irrigation projects.

When the policies are formulated, a specialattention should be paid to those groups most inneed. in practice the iðentification andclassification of those groups would not benecessarily always that easy. If a special supportis to be given, the indicators determining, sayincome lavels or the support required, have to besuch that they can be easily and reliablymeasured.

In Harispattuwa Electorate, Sri Lanka e.g. thepercentage of the households receiving foodstampswas 83 ìn one of the villages, but actually only5% of the households were entitled to receive them(University of Peradeniya 1983). This indicatesclearly that if the foodstaiups had been used as acriterion for a special support regardirig latrineconstruction, almost 80% of the households wouldhave enjoyed the support basically allocated onlyfor the poorest part of the population.

If the construction and use of improved latrinesare engouraged, and the external assistarice are tobe provided, the cominon strategy is to supply goodquality materials for construction. They could bemade available and then sold to the builders orthey could be given to the builders free ofcharge. Also subsidies have been used to engouragethe households to build iinproved sanitatìonfacilities, but even in that kinð of programmesthe builders have covered at least part of the

13

costs.

The national policy in Lesotho is that it is notcurrently appropriate to provide grants ormaterjals subsiðies for building of iinprovedsanitation facilities (Koina 1989). For thosehaving not sufficient cash to pay for the latrinea loan scheme has been set up in conjuction withLesotho Bank.

In Botswana the sanitation prograiniue proinotes theuse of vi:P latrines through a policy of subsidizedself—help construction (Land et al 1989). Thehouseholdt contributes 42% of the cost which isabout USD 115.

The Agua.runa and Huambisa Jungle Indian Cour~ci1had developed what was considered in many ways amodel primary health care programme, yet during 11years it had failed to iìnprove the healthcondition.s because of the lack of emphasls onpreventive xneasures (Bartram et al 1988). Newixnproved strategy integrating water supply,hygiene education and sanitation is now beingdeveloped.

The donors and the consultants working for themusually have developed their own ideas onsanitation programmes often based on theexperiences elsewhere, where the conditions xnighthave been completely different. The nationalpolicies based on the local nee~s are thereforeuseful, especially if they have been defined afterlong experiences.

14

5 LEGISLATION

An exampie of the existing legislation relatíng topublic health, water and sanitation can be gi~tenfroin Sri LanJ~a, where the Pradeshiya Sabhas Act,No.15 of 1987 defines the duties of the PradeshiyaSabha regarding latrines (85-92) (Government ofSri Lanka 1987b):

85. It shall be the duty of the PradeshiyaSabha-

(a) to take effective measures to securethat adequate and proper latrineaccommodation is provided for allhouses, buildings and lands within sucharea;

(b) to provide such public latrineaccommodation as it is necessary at allplaces of public resort within itslixnits; and

(c) to ensure that all latrine accomodationboth publjc anð private within it~liinits is maintained in proper order andcondition.

This kirid of iaws and regulations should beformulaterd and introduced bearing in mind thatthey achieve nothing unless they can beimplexnerxted and enforced.

Samura (1989) listed one of the problemsinhibiting a sanitation programme in Tombo, SierraLeone that the village Development Coininittee haslittle or no interference in the enforcement ofpublic health laws because of personnalconnections.

This shows clearly that the regulations and lawsalone are not enough. There has to be a firmcoxnmitment from the users to builð the facilities,and use and maintain theìn properly. Theauthorities also should carry out thelrresponsibilities properly.

15

6 CtJLT~JRALASPECTS

Cultural practices can be either beneficial orharmful t.o health and resistant to health care andhealth promotion

Scotney (1986) described some exaìnples of beliefsand traditions involved in peoples behaviourregarding water and huxnan waste; the MasaiManyattas of East Africa, and the isolated Jebelvillages of western Sudan believe that the membersof a family cannot contaminate their own watersupply. Soìne tribes fear utilization of theirwaste to injure them by witchcraft, and in soineAfrican tribes children are tolð that theirfathers, who spend much time away from household,do not defaecate and are superhuinan.

To get people convinced to build excreta ðisposalfacilities, and maintain a good personal hygieneis certainly a difficult task if changes inbehaviour are not appropriately promoted in thatkind of situations.

In Lesotho, for instance, males and females do notusually use the same cubiçle in coinmunal latrines,rental units and in schools.

In some coinmurxities in Lesotho diarrhoeal diseasesare not seen to be caused by contact with taeces.Illness is linked with the seasons, witchcraft orthe weather (Dlan.gamandla 1985),

A common belief in many societies is thatchi1dre~s and infants faeces are less . harmfullthan thoseof adults. With regard to intestinalworm transmission childrens faeces are moreimportant source of infection for others, andshould be disposed in a safe way (Cairncross1988).

Kejnänen (1983) described the situation in SriLanka:

Iri some families the children do not usetoilets at all because they are afraid of thepit. In these cases children urinate arxd

16

defecate in the garden and mother carries thefaeces to the toilet or throws it under thetrees. Small childrens faeces seem not to beconsidered as dirty things as adults faeces.So, children are usually allowed to defecateeverywhere.

In Kenya an interesting social change caused bythe introduction of a digester occured among men(Batchelor 1985):

Before the introduction men would not use alatrine but continued to go into the bush.The biogas generated excitement for the wholefainily. Giving four extra hours of good lightin the evening, it increased the familysenjoyinent of life. So it became a noble thingto contribute to the digester.

During the interviews in two West Bank Palestinianvillages, villagers explained that latrines ha notbeen part of traditional bedouin life, but twofactors had engouraged their acquisition oflatrines from 1965—85: the effect of school on thechildren of the village and the demand forlatrines from visiting guests (Smith 1988).

Scotney (1986) also stated that the chief factorof motivating people to construct and use latrinesis social pressure.

The Orangi Pilot Project in Karachi, Pakistanstarted also a womens programme includìng healtheducation. Because custom requires women to stayinšide their homes, the project introduced mobiledteams which have meetings with women activists inthe lanes (Mustafa 1985).

In Pemba, Mozambique a survey on latrine ownershipshowed no significant difference between differentreligions (Muller 1988).

In cultures, where people are using water for analcleansing, the latrines with pour flush bowls arepreferable, and often used for decades.

17

7 PROJECT PLANNING AND IMPLEMENTATION

Within a single country there inay be as many ruralwater supply and sanitation policies as there aredonors. In the past, so—called donorcoordination has often failed, but the climatehas now improved.

The role of water authorities in water supply anðsanitation projects have been usuallyoverestimated and the servlces of the healthauthoriti~ have been uriderestixnated,

The donor agencies have been providing support tothe water authorities, but not a sufficientsupport to the health authorities. Hence the roleof the health authorities, since generallyspeaking they are better struçtured to bepromoters at community level than the waterauthorities, has beeri weak in the projectactivities. This had decreased essentially thecommunity involvement in the projects.

If the conventional top-down ìnethods wiðely usedpresently are to be rejected, and communityinvolvexnerit concept is to be developed further,project prepaparation wil]. take detinitely moretime than general.ly in the past.

ThJ.s will require accordingly substantialinvestment of staff time by donor and recipientgovernment aljke.

Rough screening tools, which can provide insìghtinto the level of service that is likely toappropriate in a particular type of community, anðmore precise tools are needed to determine thewlllingness to pay for different service levels.

Institutional analyses will have to be performedto specify the roles of different public sector,private sector, and coxniuunity jnstitutions.Technical, huinan resource, and financialconstraints will have to be identified. Andrealistic targets have to be set, and appropriateresources have to be allocated.

18

Most success has been achieved through agenciesspecifically created with organizational andmotivational skills in mind.

Aid can be only as effective as the policy

.

economic. and administrative environment in whichit operates. Aid therefore has to be concernedwith creating the fundamental conditions for itsown effectiveness.

If aid is to make a broad and sustainedcontribution, it must be concerned not only withthe proper selection, design and ixnplementation ofindividual projects, but also with the support ofbroader sectoral and national efforts andpolicies.

Multip].icity of donors and the complexity of theirseparate procedures have increased recipientSadministratiorx heavy burðen. The budgetary processof the recipient may also be inadequate to copewith the deinands of multiple uncoordinated aidactivities for domestic resources to complementthe external ones supplied by donors.

According to Edwards et al (1988) the first monthsof a priDjects life are critical because theyestablish the manageinent pattern. Therefore thereis a need to have a project start—up workshop. Thereport lists typical probleins in the first phaseof the project:

— insufficient host government support— unclear roles— unclear expectations for performance— team strife and low trust— lack of ðirection

To transfer technical information at communitylevel in ~imbabWe (Laver 1986), visual aids havebeen developed both to teach people and proinotethe prograinme (Table 11). The visual inedia forconnnunicating about sanitation was assessed andevaluated by health workers, experts anddevelopment workers throughout Zimbabwe. Also theBuilders Instruction Manual was evaluated based onthe experiences in the field, and revisedaccording].y.

-.

19

This kind of procedure will be in outmostimportance by correcting the deficiences andinconsistencies in cominunications media.

Table 11. Methods and materials used in(Laver 1988).

projects.

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tovgs-sry

In Sri :Lanka the Integrated Rural DevelopmentProgramme has followed a package approach in itstea estate programme. The coinponents of thepackage are water supply, latrines, housing

20

i:rnproveinent/upgrading along with provision ofcrèches, inaternity wards and dispensaries. Thesetting up of volunteer groups and regular healtheducation progranime was also an integral part ofthe progranime (Eckstein 1985).

Even the good health education progranime can notguarantee the success of a sanitation prograinme,if it does not taJ~e properly into account theavailable respurces. The goals of the educationshould be realistic and promote the best use ofthe ofteri limited resources0

Those with the greatest health needs are thepoor--the least literate and the least likelyto understand the connection between poorsanitation and illness or to have any extraresources, either time or inoney, to devote toheaith. Nor in inost instances do the poorhave ready access to health services (Yacoobet al 1988).

For the very poor, additional considerations incoinmunic~tion and in finance must be taken intoaccount. Ideally, if a country or coinmunity wantsto provide some sort of subsidy to poorerresidents, it is better (for inany reasons, butespecially for efficiency) to do so through a formof general support rather than trough specialprovisions in a particular sector.

7.1 Baseline Studies

According to Na~ayan-Parker (1988) baselinestuðies can be invaluable in discovering cultural,social, psychological, physical and organizationalfactors of relevance to water supply andsanitation. However, from the planners point ofview acadeiuic baseline studies have often been oflimited value, especially when the tiine—lagbetweefl the start of the study and the resultspresentation has been long.

It would be useful, although sometimes expensive,to study, how much contamination takes placebetween when water was collected and when it wasconsumed, and hygiene and sanitary habits in the

11BJ~ApyINTAT1(-)~SJ~~RFFER~NCECENTREFOF~COMMUNITY WATER SÜPPL~AND

SJ~INJTATION(IRC)

21

coimnunity. If the study is not carefully plannedand executed, the results are difficult tointerpret and pointless.

This kiLnd of studies could give valuableinformatiLon in both local and global scale.

The baseline household survey in Belize (Campell1988) had three purposes. First, to document watersupply and sanitation conditions in each villagehousehold. Second, to increase the familiarity ofvillage residents with the goals, objectives andprocedures of the project, and third, to introduceproject staff to residents.

The st:ate of the primary health careinfrastructure should be well documented beforethe start: up of the sanitation programmes.

7.2 Finance

The Asian Development Ban~ç (1986) estimates thatin the 1970-1984 period about 70% of allinvestments in the water supply and sanitationsector were allocated to urban water supply, 20—25% to urban sanitation, and only 5-1O% to ruralwater supply. Rural sanitation was largelyneglected.

The economic reforms have been necessary responsesto changing econoinic conditions and will haveimportant long-term benefits. Yet in the near termthey imply added stringency, further limiting thepublic funds available for water supply andsanitation.

Significant country-by-country differences alsoexist. In Latin Ainerica and the Caribbean not asingle country invested inore than O.5% of itseconomy in water supply and sanitation even inbooin years (Munoz, cited by Wiseman 1988)

The Governinent of Sri Lanka has allocated for thewater supply and sanitatìori sector 4.6% of allcapital expenditure in the years 1980-87(Governmant of Sri Lanka 1987a). The actualperformance of the sector in the light of using

22

the allocated capital resources has not beensatisfactory, because the actual expenditure hasbeen only 3.O%.

7.3 Tiineframe

Although desperate neeðs exist now, the focusshould be on ineeting the long—term needs.

If the goal is to provide sustainability andreplicability, this would definitely require alonger time than usually adopted in the executionof the water supply and sanitation prograimnes.According to Yohalem et al (1987) experiences haveshowri that generally five to seven years isrequired to get community invoived in project, andto transfer technologies and techriiques tocoinmunity leaders and official counterparts.

7.4 Coinmunity Involvement

Coiiununity participation, the organizedinvolvement of a coininunity in a developinenteffort, is expected to reduce increasinglyproject costs, increase service coverage andencourage technical and actininistrativeflexibility. It is also anticipated that itwill help improve operation and inaintenancestiinulate broader socio—economic developmentand enchange coininunity capacities fõr problemsolving (IRC 1988).

However, it is important to realize that soinecoiumunity members are more interesteç~ than othersin improving water supplies and sanitatìon.

Briscoe et al (1988) stated:

There are two important dangers. First, itiS easy to roiuanticize the community,expecting villagers in developing countriesto demonstrate a cohesion, capacity, and wìllthat do not exist elsewhere in eitherdeveloping or developed countries. Secondly,it is wrong to trivialize the notion ofcominunity participation using this as an

.p

23

euphemism for low—cost labour.

The approach to conununìty involvenient has perhapsnot been realistic enough, because often it hasnot been seen that community manageiuent willrequire definitely adequate support from thegovernment.

,It is local people themselves, not thosetrying to help them, who have the mostimportant role. The coinmunity itself must bethe primary decision maker, the primaryinvestor, the primary inaìntainer, the primaryorganizer, and the primary overseer (Briscoeet al 1988).

Governnients and external agencies inust estpblishthe environment in which communities canconstruct, operate and manage improved facilities.

In the Orangi Pilot Project in Karachi, Pakistan,the experiment has been; first to persuade theresidents that if they do not organize themselvesto iinprove their living condìtions, nobody will doit for them, and they will face greater hardship;second, to try to reduce the cost of a standardsewerage system and third to provide theinterested residents with a low—cost technologyand the technical guidance and assistance forconstructing it, and to train theiu in itsmaintenarice and upkeep (Mustafa 1985).

This self-help programme started in Septeiuber1981, and by Deceinber 1984 1273 of a total of 3072lanes had constructed sewerage lines, and of 43424houses 20470 had built sanitary latrines connecteðto the underground sewerage lines in the lanes.

Drucker (1985) did a review of 80 countries wherewater projects were managed by an internationalagency which was a leader in its strong coininitmentto the social eleinents of development. Its Boardof Directors has made it mandatory that coinmunityparticipation must be an integral part of anyproject.

According to his interpretation only 11 of the 80indicated that the communitv Dlaved some Dart in

24

planning.

Eng et al (1987) stated that it was essential toinclude participation among the objectives of theproject; it must be the intended goal of projectplanners.

Because of womens cent.ral role in householdhygiene, food preparation, and childcare, hygieneeducation programines are of necessity for women,and, because woman—to—womancoiiununication in suchinatters is more effective than inan-to-womancominunication,the prograinmes should usually beconðucted by women.

The Technology Foruin for Appropriate Developmentof the tîniversity of Ziinbabwe supportedintroductory courses for women resulting in theconstruction of over 17000 VIP latrines. Often thewomen organized brick—making to finanze theacquisition of other latrine componenets (Katarecited by van ~Jijk—Sijbesma 1985).

7.5 Private Sector

Some key services are best perforined neither bythe governinent nor by the coinmunity, but theprivate sector. A properly equipped and suitablyrewarded private sector can be an effeptive bridgebetween the governinents liiui.ted capability toservice dispersed coinmunities and the conununitysshortage of skills, tools, and materials.

In the past central governinerit agencies took alarge role for theiuselves, frequently ignoring thepotential of private sector institutions and localinitiatives. International aid agencies initiallywelcomed a centralized approach, as this appearedto be the best way to reach the largest nuinber ofpeople with improved services.

Non-governinental organizations (NGOS) can oftenplay a valuable role in identifying iinprovementsthat conuuunity menibers want and have the capacityto build and niaintain and working with coinmunitiesto construct, operate, and maintain thefacilities.

25

Briscoe et al (1988) recommended:

Public sector: proinoter, educator,regulator, and in some cases, financier orfina.ncial intermediary. Coinmunity: owner,builder, iuanager and operator. Privatesector: provider of special skills,inaterials, and services to the community.

7.6 Choice of Technology

It is ironic but true that inoperative watersupplies are found in areas where bicycles,radios, irrigation pumps, ceiling fans, andsinall industrial machines are reliablymaintained. It is apparent that what is atfault is not the complexity of thetechnology, but the top—down approaches beingfollowed iri the design of systems and themaintenance of facilities (Briscoe et al1988).

BI4Z Sector Paper (1984) stated that consuiners inayhave to accept lower, economically feasible supplystanðards and simpler technologies. This isjustified because in many cases higher servicestandards do not only improve health conditionsbut mainly enhance users convenience.

The availabìlity of water even during the dryseason must be guaranteed before introducing pourflush latrines. If there is scarcity of waterduring the dry season a direct pit latrine with aremovable pour flush bowl can be constructed. Whenthis type of latrine is provided with aventilation pipe, it can be used as a vIP latrineduring the dry season (Cotton et al 1987).

Ground conditions will have an effect of thetechnical solutions for the latrine construction.If the ground is rocky1 bed rock is near thesurface or if the groundwater table is high, deeppits are not feasible. The superstructure and pitcan be raised in such situations or even thedouple pit pour flush latrine might be consideredfeasible because of the pits are rather shallow.

26

Also an introduction of the Vietnamese type oflatrine could be considered.

The location of the latrine is quite important.Although in many soils the movement of pollutionis quite sinall — perhaps as little as a metre ortwo — it: will be sensible to dig pits as far aspossible from drinking water wells (Pickford1988).

If in sparsely populated areas people are coveringtheir excreta with soil, they should be educatedto bury j~ at least to a depth of half a inetre,which is enough to contro]. larvae of flies andworms (Nordberg et al 1989).

Small children may find this cat method safer touse than a conventional latrine.

The simple pit a metre square and a metre and halfdeep would last for two to four years for a familyof six people (Pickford 1988). If there is plentyof space around the house this kind of practicewould be sufficient sanitation measure.

Ministry of Health inspectors in Ziinbabwe village-level sanitation programines have rejected lower—cost structures znaðe with poles, grass and mudbecause of their low life span (Morgan 1988). Thefamilies are receiving a subsidy in the forin ofmaterials.

The DANIDA supported rural water supply andsanitation project in Sri Lanka has also givensubsidies on condition that the latrines are inadeof acceptable inaterials and are of permanent type(Kainpsax—Krüger 1989).

This kind of practice could be adopted ifmaterials of proper quality are made locallyavailable.

Winblad et al (1988) described that inost of theSIDA-funðed Blair latrines had no fly-screenbecause the recommended stainless steel screen wasnot availablé in Zimbabwe. The recoininondation ofthe report was either to change the technologiesor to start production of thìs key item within the

27

country.

Experience iri Lesotho has shown that communallatrines are not appropriate and that it is betterto lend inoney for the construction of latrinesthan give ìt away (Blackett 1988).

In rura]. areas fly-screens, vent pipes andreinforcing bars are sold through the network ofclinics, while district prisons are making andselling concrete slabs.

In Mozanibique mainly the lack of building materialforced to give up the idea of a roofedsuperstructure and a ventpipe (Brandberg 1985).The szne].1 problem and fly control was solved byusing a light tight-fitting lid of high qualityconcrete, cast iri the hole of the non—reinforceðlatrine slab. The additional advantage was alsonoticed; it stopped cockroaches, the permanentresidents of pit latrines.

According to Muller (1988) traditional latrineswere very short—lived being replaced after lessthan two years of construction in Ziinbabwe. Thiswas mainiy because they had filled up or poor soilconditions had led to pit failure.

Efraimsson (1987) did not recommend thetraditional pit latrines due to various prob1e~isencountered with thezn:

Whenever water is used in toilets forbathing, anal cleaning etc. a pour flushtoilet can be feasible. if constructed withalternately used pits it can be consideredthe best available technology for on-sitesariitation.

Nordberg et al (1989) pointed out that yIP lptrinehað been advocated too widely an~ toouncriticall~:

Problems of high costs are solved by SIDA-funded subsidies to private households.Problezns of non-availability of transport andmatErials are solved by SIDA-funded iinport ofvehicles, fuel, reinforcement and flyscreens.

28

The programmes are therefore not sustainableby local resources.

In the future the deinand for food will be immense,and accordingly the possibility of using compostedhuman excreta as fertilizer should be encouragedwhenever possible and recommendable. Also thedemand for household fuel and energy will increasewith population growth. Accordingly if long-terinperspective is favoured, technology selectedshould be promoting composting anð biogasproduction.

Nordberg et al (1989) described that experiencesfrom the UNICEF-funded Wangingombe Project inIringa Region, Tanzania, showeð that the usersaccept to reznove the coznpost, and the demand forfertilizer is now so great that even the old pitlatrines have been dug up.

Various types of latrines were tested inBangladesh (Gibbs 1984): water-seal, iinproved pitwith a chute, ventilated improved pit, vietnamesetype, arid IvS (International Voluntary Services)type made entirely from locally availableinaterials (bamboo). In September ].982, thetechnology was evaluated. The main finding wasthat if there was high adult female usage oflatrines, there was low child usage; anð viceversa.

This finding indicates that if the superstructureoffered privacy, the children were afraid to usesuch kind of a latrine, and the substructuretechnology became a].most irre].evant in thisregard.

The recommondation was to direct the attentiontowards the users needs rather than atteinpt touse the perfect engineering solution, if the useof the latrines is to assured. To guaranteewomens privacy, and to make children feel safe,it was recominended to place the latrines insidehouses.

The second finding was that the IVS type oflatrines were not functional, because bambootenðed to degrade quickly. This shows clearly that

29

some local mpterials can be inappropriate, andshould not be used.

Kein~nen (1983) described in the study ofHarispattuwa, Sri Lanka:

Even if the latrines are not very far frointhe house they can be in very difficultplaces. People have to climb up and down thehill. That is why urinating and defecatingduring the night usually takes place in thegarden. That is also why children often donot use latrines.

To guarantee the vital usage of latrines,especially by children and older members of thefamily, it would be advisable to investigate thepossibilities to introduce the type of latrine,which could be connected to the house. This wouldoffer increased convenience also to the otherusers.

A limiting factor in the selection of technologyis also iack of space in squatter settlements andin sozne densely populated rural areas e.g. in someparts of Kandy District in Sri Lanka. In inanyinstances eznptying of VIP type or pour flushsingle pit latrine is not viable and practicable.

7.7 Production and Coristruction of Sanitation Facilities

In Zimbabwe the latrine slabs were znade by twelvecominunity latrine construction co—operatives as aresult of a self-help pilot project (Paqui 1988).Slabs which sell for USD1O each carry a life-timeguarantee, and znore than 25000 slabs have beensold and installed.

In Sechura, Peru the introduction of iinprovedsanitation was done by building first publiclatrines and then credit were maðeavailable forself—help groups to construct domestic modelsafterwards (Maber 1989). Local craftsmen wereinvolved at all stages of production, and thjsensured the acceptance and replicability oftechnoloqy within the coiiununity.

-š

-.

30

Iri Botswana the household is responsible for pitexcavatian and construction of superstructure(Land et. al 1989). The District Council is incharge of substructure construction. In some casesit also offers a free door as an incentive forrapid completition.

In Sri Lanka the conunon procedure in externallysupported programmes is that the household isresponsible for construction of the latrine, andthe programmes will provide subsidies coveringabout 25-75~ of the inaterial cošts depending onthe donor agency. The prograinines normally providesalso latrine slabs and squatting pans with siphoristo the households.

According to U Tin (J et al (1988) the local masonsin Ayadaw, Burma were trained in production offerro-ceinent squatting plates in the townshiphospital compound. The construction of latrines bythe households was supervised by the villageworking committee.

Efraimsson (1987) recommended that in WesternProvince in Kenya a possibility of setting up alarger central production unit capable ofproducing pre—stressed concrete latrine slabsshoulð be investigated.

This kind of a unit is feasible, if good qualityproducts, which could be re—used, can be producedarid when the production and transportation costscan be kept lower than the costs of on—siteproduction or the costs involved in sniall unitproductiori. The large unit can also createpermanent jobs, what should also be consiðered anadvantage.

Although user participation is recommended and anecessity, the sustainability regarding productsand to some extend the introduction of new ideasregarding technology advancements, and involvementof private enterprises in production andtransportation should be promoted.

31

7.8 Usage and Ma~Lntenanceof Sanitation Facilities

The provision of sanitation facilities, perhapsthe easiest part of the conununity water supply andsanitation projects, does not ensure theachieveinent of health benefits. The communityshould also be inotivated to use and maintain thefacilities properly.

The require~ mo~ivation and education should becarried out by agencies involved in coininunitydevelopment and cominunity resources inobilizationrather than by agencies norinally responsible onlyfor t.he development and provision of physicalfacilities.

A special attention should be paid to older peooleand children, because it is important that thewhole coininunity will take use of the improvedsanitation. Parents should also be educated thatchildrens excreta should be disposed properly inthe latrìrie.

The need of keeping the latrines (slabs, doorhandles etc. depending on the type of latrirze)hygienically clean should be communicated clearly.

The maintenance and repair practices should beaddressed efficiently within the users, becausepoorly inaintained facilities quite easily willdiscourage people from constructing and usinglatrines,. Also such facilit.ies mean perhaps evengreater inconvenience to the users than theirearlier defaecation practices.

Kamau (J.983) stated that in Kenya in squattersettleinents houses were owned by absenteelandlords who did not take care of the latrineinaintenance. Since tenants were not sociallyorganized to take any action, nobody waseffectively responsible for maintenance, andoverfilled pits and collapsing superstructureswere a coinmon sight.

Muller (1988) described that in Ziinbabwe improvedlatrines were kept clean and covered better thantraditional ones, mainly because of the purpose—inade covers. Children did not start using the

32

improved latrines younger than they did thetraditional ones. Latrines were used by childrenat younger age in the householðs of higheducational level than elsewhere. The economiclevel c)f the households had only a weakcorrelation with the age at which children startedusing latrines.

7.9 Environinenta]. Impact

The risk of contamination of water sourcesis particularly great in areas with a highpopulation density, such as urban and urbanfringe areas, large planned settleinents,inarkets, centres, etc. In such areas, thechoice of sanitatiori technologies ispart.icularly critical; low-cost technologiesSUCh as pit latrines may actually increasethe risk of contamination of water sources insome cases, such as urban fringe areaslocated near water courses (DANIDÃ 1988).

Àccording to Efraimsson (1987) the nuniber ofhouseholds without latrines is presenting aserious threat to the entire population in WesternProvince in Kenya. Traditional water sources inthe area are heavily containinated, and the presentwater supply project in the area is alsodeveloping groundwater resources.

If fired bricks are to be used for construction oflatrines, the effects of wood consuinption ondeforestation in this regard should be evaluated,and considerations should be given to safeguardthe erivironment.

7.10 Review and Evaluation

Thorough assessment of overall objectives,target groups and external factors thatdetermine success or failure is oftenlacking (Introduction to Logical ProjectAnalysis, NORAD 1988 in NORAD 1989).

According to McGarry (1986) the Logical FraineworkAnalysis, is currently used as a standardized

33

project planning format by several internationalagencies such as UNDP, CIDA, USAID, and GTZ. Inthis inethod evaluation is incorporated within thefrainework covering all levels: efficiency

,

effectiveness. and impact.

In addit:ion to external review and evaluation,also in-•house project review workshops should beconducted.

The outcomes of such review Workshop could beaccording to Frelick et al (1988):

- a better understanding of the objectîves,status, and planning of the project

— participants come to know arid appreciate oneanother better

— wrjtten agreements can be done on howcooperation can be iinproved

— written statements can be formulated and agreedon key proj-ect needs, management structure,procedures of monitoring, coiuinunication,frequency of meetings, reporting relationships,and horizontal coordination

— time schedule for major project activities canbe prepared and agreed

Edwards (1988c) de8cribed the goals of a projectmid-teriii evaluation workshop:

— define the management functions— exchanqe ideas about the management structures— improve conflict—management skills— evaluate project strategy and modify it as

needed— review and revise as needed the agreements

between counterpart institutions- strengthen interinstjtutional relations and

improve coordination— define the roles— incorporate the results of the workshop into

draft regional and project plans

Briscoe et al (1986) stated:

Because economic and social justificationsfor water supply and sanitation programs areInore likely to be dominant in urban than in

34

rural settings, it is usualiy in ruralsettings that information on the healthimpact of water supply and sanitationinterventions becomes critical to investmentdecisions, and thus it is often in ruralsett:ings that health ìinpact evaluations willbe inost useful to planners deciding on thelevel of resources to be devoted to the watersUpply and sanitation sector.

Even well-designed scientific studies have foundit difficult to isolate direct effects of waterand sanit:ation iinprovements on comanunity health.

The results of health i1npact evaluation (HIE)should be readily available, i.e. a HIE shouldlast 9-12 inonths in orðer to give required anduseful information to the planners of water supplyand sanitation programs (Briscoe et a3. 1986).

The benefits of the information generated by anevaluation of a project are dependent on the sizeof the next project to be undertaken, and bear noparticular relationship to the cost of the projectthat is to be evaluated. Especia].ly, if theinformation is to be used to replication of aproject on a large scale, the benefits on thehealth iiopact wìll be large.

Additional social and economic benefits from theprojects should also be evaluated, and attentionshould be paid to possibilities for intersectoralcooperation to get cominunity inore involved in itsown development and to get people motivated toutilize fully the services constructed.

Miniinum evaluation procedures (MEP) by WHO (1983)recominended that the following should beevaluated:

- functioning of the facilities— utilization of facilities- health impact- proportion of households having improved

latrines- sanitation hygiene— sanitation reliability— cultural acceptability

35

— health education

In evaluation a special attention should be paidto the defaecation practices of children. Ifchildren are not using the latrines constructedand contiriue to defaecate around as earlier it islikely that health status will not improve.

National support system and other communitydevelopment programanes should be also evaluated.

Smith (1989) proposed that monotoring the rates oflatrine acquisition over a period of inany yearswould provide a better understanding than a singlepoint measureinent.

7.11 Education and Notivation

If people in the developing world are tohave radically improved lives, it is first ofall necessary to teach thein to bedissatisfie~d with the present situation andat the same time inake thein appreciate howthey can work towards a better future(Bidwell 1988).

The introduction of latrines in Finland in thel9th century is described by Vuorela (1975, citedby Katko L989):

The words used for referring to the latrinewere mostly of foreign origin (huusi, hyysi,inakki, pikkukainari, priveetti). This wouldindicate that the latrine was first introducedin the upper c].asses. Still in the 1880sinformation about latrines was spread bysoldiers who had been drafted for the reserve.In the 1890s most houses in centralOstrobothnia were equipped with a latrine. Itwas, however, seldoin used, because who wouldcare to use one (Relander 1892).

In societies where inost people do not proceedbeyond the primary stage, priinary school takes ongreater role in health proinotion. The priinaryschool health education syllabus should thereforeproperly designed and iinplemented.

36

The foll()wing ways could be useð in most effectivecoinbinations for hygiene educatiori: school, adulteducatioii prograauanes, sectoral programmes oftraining and extension services, non—governmentalorganizat:ions, religious institutions, maternitywarðs, mass media, and person—to—personCOifliflUfliCfttiOfl.

Behaviour changes can occur only when healtheducation is follow by tt~e changes in the physicalenvirpnluE~zÏ~,. It is no doubt very difficult to getpeople not to use containinated water sources, ifthere is no alternative.

School health action plan should be developedincluding: upgrading school sanitation facilitìesand sanitary conditions, teaching basicsanitation, expanding and improved healtheducation programines, iininunization, medicalexaininations, inspections of sanitary conditionsof schoois and school yards.

tlsing la.trine-cleaning as punishment should bediscouraged as it tends to lower the status oflatrines (Dlangamandla 1988).

In higher education the curricula developmentregarding the environmental hygiene should followthe knowledge level required in the correspondingbranch of science.

Winblad (1987) suggested that health and latrinesshould be treated as separate issues:

Better health is achieved by a faecal freeenvironment. Households build latrines forother reasons than health (privacy,convenience etc.) .

The different objections to latrine constructionin the coinanunity, like an unwillingness to sharethe latrine, fear of contact of excreta, flies,cost or time involved in construction etc. have tobe treated ðifferentiy, and the education andinotivation campaigns should be formulatedaccordingly.

If the connnunity has some kind of excreta disposal

37

systems, like bucket latrines, the education andmotivatic)n could be directed to the constructionand usage of improved facilities, like pour flushtoilets etc.

The coinmunity sub—groups (tenants, owners etc.)will require often different kind of approaches inthe education and motivatìon progranune.

The level of coanmunication and advice regardingthe const:ruction of the facilities will depend onthe selected technology. The detailed inforanationand technical aðvice is required by the builders,if they are to construct the improved latrines bythemselves.

If the selegtion coulð be done between variouslatrine types people should be inade aware of theadvantages and disadvantages of differerit designsin order to allow thein to inost suitable one fortheir specific needs.

Hygiene eðucation packages covering all the basicfacts about environmental and personal hygieneshould be formulated to aneet the coaninunitys needsto take the full advantage of the improvedfacilities.

Narayan-Parker (1988) showed quite clearly thatunless women and children become convinced of Lheneed to change the way they handle drinking waterat home it will continue to be polluted, despiteimprovements at source.

Simpson-Hebert et al (1987) described a goodhygiene education programme active rather thanpassive. The report also emphasized that inostpersorial hygiene is learned in the first fiveyears of life especially the habits regardingurination and defaecation.

Torres et al (1988) recoaninended that target groupsfor a social marketing programane would be; inothersof toddlers (aged 1-3) and preschool children(aged 4-6); primary school children and melnbers ofindigenous comanunes, sporting clubs and farinergroups.

38

If a new technology is introduced, definitely asuitable coxnmunity education progranuue shouldsupport that action.

According to Yacoob et al (1988) social marketingoffers a valuable approach solving problems inwater supply and sanitation that are related tobehaviour rather than technology.

Eoma (1989) points out that the VIP latrine isxnarketed in Lesotho as affordable but not ~ust forpoor peop~ as this would reduce its status value

In Karachi, Pakistan a social worker spent severalmonths in a squatter settlement before thecominunity lost its skepticism and participated ina sanitation prograinme (Quratul Ain 1984, cited byMcGarry 1986). The local cricket club was thefirst group to want the streets cleaned so that itcould play cricket without getting ballsconstantly soiled.

Hasan (1988) points out that there is no longer aneed to motivate the people in Orangi township,Karachi. Lanes are organizing themselves andcontact the project for technical assistance. Theproject relying ort coxninunity involvement hascaused a major and social change. The lanes arecleaner and healthier, and the people haveimproved their houses and the value of theirproperty has gone up cortsiderably.

In Mozaxitbique it was discovered that people inostcoxnmonly learned of the improved latrine fromexistinq~users (Muller 1988). Also a high nuiixberof people were infornted on improved latrines bythe local politica]. authority.

Some key elements of the the effectivecoxinnunication and health education are suinmari.zedirt Table 111.

Coxnmunications support guide: whichmedia to use (Laver 1986).

Pro~sct— K.y hota. M.ttrod of oosr.nurrtc.tion support

Plsnning ph.sr

Communlty neerts surv.1

MobìltnUon plrssr

lmpl.m.nt.Ilon ph...

M.int.n.nc. plia..

Establi.h cont.ct wtth k.y l..d.r.

Community nrid. .urv.y.g aiarss probl.ms. ns.d. .nd prlonrrss

Di.cu.. trchnology options/proj.ct brn.frt.

Eriptsrn .bour support orginizatlons .nd $tructuiai

F.cilitalr drci.ion-m.king through group.

Discun communiry obj.crrvs./conrributiorrs

F.cilitatr community org.nintion througli loc.lm.n.grmrnl itriicturi

Choon projrct iitr wirh tli. psopls/lrsrt.rs sndcommunity-basrd wo,k.rs

Provids inforrn.tion .upporl

F~crlirarr drlivsry .upport mst~nalsr. c~msnt.rc.

Encoursgr m.rrlmi,n communlty support for prot.ct

Encoursgs cornplrtion of projrcr

F.cilrtare vrsrts by k.y ls.dsrs/Iocal .urhonrl..

Encoursgr pl.c.mrnr ot high vslur on l.cility

F.crlrr.rr s.lsction/rrsining of msrnrrn.ncr p.r.onnsl

through loc.l man.grrn.nr strucrins

Est.bli.h .upponjr.lsrrsl sy.rrm tor m.rnr.n.ncr throughloc.l m.n.grrn.nr .tructurrs

Fscr ro fscs conr.ct wrth k.y l..dsrs

Sm.ll group discuisions

Visirs to othsr proj.crs

Psycho-soclsl m.thods for problsm .olvlngsg picrur cod.s

Grnup/prttic m..rrngs/pronrotron.l m.dr.

Posrsr Th. Psop1s oflrmb.bw. .rs Luldrng Latnns.— Joln îhsml

Lssflsr.rr summsry lr.flsrs Build . Larrrns

Visrr. to oth.r succss.ful orojlcr.

~lnatnictlcrn.l supporr

rt Build.r. tnsjrucrton.l Munusl

lntorrn.rron l..flsr.r.. sranm.ry i..tfsrs Bulld. Larnn.

On srrr sninncs wh.r, nscsn.ry

Msrnr.n.nc. u.inlngsg p.rsonat sppro.ch

M.rnrsnancs rsmtndsrls sncaprut.t.d tssflsr. ta. tor your Laoirr•

C.rmlc ufss tor pt.srsnng srro conipl.t.d .rructrns

Othsr hygirn. lnr.rv.nrions (h.ndw.shrng .rc.)

Aar.nsk rithcar. promotron.l snd rn.tnicrrorr.l support m.dr. d.v.lop.d tor Zlmb.bw. pro~~ct

7.12 Training

To review the training of economic planners,acricultural extension workers, waterengineers, teachers, environmentalspecialists, and other professlonal groupswho are to work in health-related fields, inorder to secure an adequate understanding ofintersectoral relationships with healthwithin their sphere of competence

t(Resolution W11A39.22 adopted by the Thirty-ninth world Health Assembly, May 1986).

39

Table 111.

40

The Water anð Sanitation for Health Project (WASH)has trained nontechnical health, social, and otherworkers already working at coinniunity levels inlatrine construction, solid waste disposal andsullage disposal (Iseley et al 1984). Theseworkers would work with coiniiiunities to proinotelow—cost technologies.

7.13 Research

To encourage and support action-orientedinult:idiscipl inary research focusingsocioeconoinic and environinental deterininantsof health in order to identify cost-effectiveintersectoral actions for iniproving thehea].th status of disadvantaged groups(Resolution WHA39.22.).

Research, and especially applied research has hadunfortunately considerably low status when the aidfunds have been allocated in the past. If thefocus stays on the sustainable and replicabledevelopinent in environinental sanitation, to knowtIie nuinbers of constructed facilities is notcertainly enough.

How can desirable behavìour changes be obtained,if the socio—cultural environment is not known?Are they obtained after the prograinme completion?Is the issue of introducing VIP latrine correct?Are the a.dininistrative procedures, monitoring andevaluation actually helping to reach the targets?Are the allocated funds enough to obtain thetargets?

41

8. CONCLUSIONS AND RECOMMENDATIONS

The goals set for the International DrinkingWater Supply and Sanitation Decade (IDWSSD)will not be achieved (Refice Stateinent1988).

Education

Water— and sanitation related diseases can beeasily prevented by introducing and practicingsimple measures. The transmission of diseases, andthe importance of personal hygiene such as hand—washing should be understood. Improved sanitationand water supplies are also necessary as well asavoiding contaminated water and food.

The behavioural patterns are obtained during thechilcthood, and therefore priinary schools shouldprovide children and through thein the familieswith the required awareness and knowledge aboutthe good hygiene practices.

The user education should give a clear picture tothe users why latrines are neede, how the latrinesare to be built properly, and how the latrines areinaintained.

Since people are in most cases aware of thediseases caused by unhygienic conditions, therequired behavìoural changes can be obtained byinaking the hardware component available.

User education is also required if the technologyfavouring reuse and recycling of huinan waste is tobe introduced. This is absolutely of inajoriinportance considering population growth foodproduction. energy requireinents. and environinentalpollution.

Coinmunity Invo lvement

The coinniunity involveinent should not be regardedjust as a meaningless philosophy but as a keyfactor, if the log—term objectives are to be met.

42

The people should be encouraged to act fortheinselves for improvement and change. Thestrengthening of local self—help initiatives incountrysi.de and urban sluin areas should be thecoininon interest of all the parties concerned;governmerit agencies, non—governmentalorganizations, donors, and people themselves.

Unplanned and uncontrolled infrastructuredevelopment should be avoided, and environmentalmanagement through coininunity participation shouldbe practised.

Health coininittees should be established in thecoinniunity itself to provide the continuity of theexternally supported programmes.

The effectiveness of the programines can beimproved through well—chosen coinmunicationstrategy.

The community involvement should be innovative,and it should rely on the coinmunitys prefererices.The GTZ supported rural water supply andsanitation project in Sri Lanka approached thevillagers, and requested them to identify thevillage—level organization through which thesanitation prograinine was to be channelled. Thevillagers in that district usually chose theFuneral Society as a coordinator for thesanitation activities.

The sanitation prograinines should be, of course,performance—oriented, but appropriate time shouldbe allowed to get to know the people to be enteredinto partnership, their needs and preferences,problems and ideas. Too often the baseline studiesand socioeconomic household surveys are offered asa textbook solution, and in practice the realfainiliarization has been neglected because of thepressure of the rapid achieveinents in nuinbers ofsanitation facilities constructed.

Institutional Aspects

Because the necessity of coni~iunity involvement anduser education has been largely accepted and

~JBRARY ENCE CENT~

FORCOMM~~~WP~1ERSUPPLY P~SAN~TF~tOM(tRC~

43

included in the strategy, the focus should beperhaps riow inore on the 1ega~. adininìstrative andmanagerial fraineworks of the environmentalsanitation proqrammes.

When the externally supported rural and squatterarea sariitation and, why not also water supply,prograinines are dìscussed, the better hostinstitutions would be those with experienceworking wìth local communities. If water supply,sanitation and hygiene education are integrated,as they often are, the ministries dealing withwater supplies must be naturally involved, butinerely only when adininistrative matters areconcerned or technical assistance and expertise isneeded.

Every effort should be done that the prograinmescould ba carried out in existing adininistrative,econoniic and technical infrastructure of hostcountries. The roles of external supporters shouldbe limited inerely to those of financiers andrepresent:atives of financiers/consultants with therequired professional skills.

The project docuinents when prepared should be morespecific wìth clear objectives and indicators,stating what is done. how and by whoin, when and atwhat cost~.

Huinan Resources

Unfortunately often there are very few coiniuunityproinotion~ professlorials. socìal scientists

,

epidexnilogists and publlc health experts in ruralwater supply and sanitation projects compared tothe nuinber of inanagerial and technical experts.This is not to say that there are too manytechnica]. experts in the projects but too fewother experts participating in preparation andiinplementation of the programmes. The projectsshould be always adequately staffed takingproperly into account the available humanresources in the host country. Sometiines thereseems tc) be a tendency that the externallysupported programmesare drawing the scarce humanresources from the host institutions where the

44

salaries generally cannot compete wjth those inprivate sector.

Sortage of trained and qualified personnel at alllevels is one of the major constraints when thedeveloping countries are trying to progress innational sector. The lack of adequately trainedand motivated inanpower as one of the majorobstacles has been identified by inany agencieshaving activities in water supply and sanitationsector.

The hunian resources aspect should be carefullyconsidered and studied before plans for theprograinmes are developed. Althoughnationalization, possible and viable, should beone of the objectives in externally supportedprogrammes, in many countries, when e.g. manningratios and staffing patterns in the sectorsinvolved are studied they generally do not yetsupport this concept.

The externally supported programmes, althoughhaving sometimes high priorities, cannot all havethe top priority and are not always of suchimportance froin the host countries point of viewthat local experts cannot be replaced withexpatriates, when the development of the sectorwill request that.

However, the seconding expatriates as Qrojiectmanagers shoulð be avoided whenever possible. Thehuman resources and capacities of private sectorshould also be considered adequately whenprograinmes are planned and iinpleinented.

Evaluati on

The evaluations should be done either on in—housebasis or by teams consisting only the experts notinvolved in any of the project activities but inreviews and evaluations. The first evaluationshould merely iinprove the management functions,operative planning and execution, and cooperationwithin the project.

The second evaluation niethod should focus inore Qn

45

policy, strategy, objectives, administrativestructures, and sustainability of the programmesin order to get fresh ideas regarding theseissues. It inay be advisable to use soine of theexperts throughout the entire project so that theywould be better aware of the progress.

The sanitation development programmes should beconsidered dynamic, because the preferences inpolicies and even in latrine designs seein to bechanging constantly. The prograiumesshould offercertain amount of flexibility in this regard, andtherefore monitoring and research projects withowri budge~ are in outmost importance.

When the effectiveness and perforinance of ttieprogrammeshave been evaluated or reviewed, oftenttie perforinance of the donor organizations,sporisoring agents, and gôverruiient ministries havebeen discussed little if anything at all. Usuallythose responsible just for the daily routineactjvities jri the environment made by the otherparties involved have been given all the beating.One could easily thirik that the ineaning of theword cooperation is sometimes interpretedincorrectly.

If the effectiveness of the sanitation prograinmesis to be measured, specific goals should beforxnulated. Those goals should be clear, simple,acceptable to all, and easy to measure.

An efflcient reporting and monitoring systemshould be developed to provide ineaningfulinformation ori the prograinine. Specialists could beused to set up the reporting and xnonitoringsystem. Far too often it happensthat projects areproducing reports after reports, monthly,quarterly, biannually, annually, review,evaluation, you name it, offering actually verylittle regarding meeting of the objectives, anduseless statistics. Quantity of the reportingshould not go ahead the quality. Objectives hardlyever include writing and reading the reports.

To improve the perfarniance of the prograinmes iri—house project start—up and review workshops shouldbe held. The outcomes of such workshops, if

46

planned and ixnpleinented properly and attended byðecision-inakers froin all parties concerned, wouldbenefit t.he execution of the programmes.

Also an in—house mid—terin evaluation workshopshould be conducted in addition to the externalevaluation, if the size and time fraine of theprograinine are requiring that.

Best Available Technology

Although the selected technology should always below—cost, perhaps the Best Available Techriology(BAT) would be more appropriate , because bestdefinitely sounds better than low in thiscontext. However, the technology selected shouldnot be such that great efforts are neededconstantly just to prevent the latrine walls orfloor froin collapsing, like it is unforturiatelyoften the case with traditional latrines.

This kind of traditional latrines will notsupport the idea of improved sanitation orreplicability, and jt makes the use of latrineuncoinfortable and unsafe. If modern structurescan be built at a reasonable price and are moredurable requiring less maintenance, the buildersinight find thein more preferable than traditionalones.

Childrens Excreta Disposal

The special attention should be paid to childrensand infants excreta disposal. Although improvedlatrines have been built in many areas, the healthimpact has beeri relatively small, obviouslybecause children do not use the latrines.

Maternity wards and programmes should be used toeducate especially women to dispose stools ofinfants properly. A separate pre—school latrinecould be built for them or they could get to use ~potty. Children would feel also safer, if latrineswould be connected or built in houses. This kindof technology woulð offer more privacy for womenrequired in some cultural environments, and more

47

conveniericy to the users during heavy rains and inthe dark~

Sustainabi 1 ity

If we think ìn commercial marketing terms thoseprograinmes which have not been successful, donororgariizations, sponsoring agents, governmentofficials and project inanagers have not met orexceeded customers expectations. For how long canthe customers be kept unhappy?

The emphasis in sanitation programmes should berather on the health proxnçtion than just on theprovisiori of the sanitation facilities. Althoughthere is a huge lack of hygienic excreta disposalfacilities, in particular in rural areas, thelong—term objectives such as improveinents inenvironinent and health should be considered moremeaningful than the number of the coinpletedlatrines.

The hardware components are only one link in along chain. The other liriks involve changinghygiene habits and other factors and can requireactions ranging from providing better education topromotinq public health programines. If anyone linkis miss~ng, health indicators may not improve.Where 1t is not possible to upgrade all linkssimultaneously, one must take a longer view,proceed step by step, and not expect to see largehealth iinprovements until the last step has beencompleted.

Although the long-term objectives should always beemphasized, the short—term objectives, likeconvenience. privacy and cleaner flouseholdenviron~e~ should be used effectively inmarketing the sanitation programmes. People tendto appreciate the Lmmediate benefits of iinprovedsanitation after having approved this concept.

However, soxne regard should be given to theconsiderably slow progress with sanitationprograinmes taking into account the fast growingpopulation in many parts of the world, and thedeclining or extremely modest economic growth.

48

Questions should be raised also on what should bedone when the soinetimes heavily subsidizedlatrines becoine full, and that will happen fromnow onwards faster and faster.

Perhaps the nuinber of funttioning facilities isdecreasing as fast or even faster than new onesare erected. Is it possible to einpty the latrine?Can the materials be re—used, and to what extent?Who is going to cover the additional costs or tosubsidize latrine construction once again?

If the questions can be answered, perhaps we wouldthink also strategies, techniques and technologiesa bit more differently than we do presently. T1ieconstruction of sanitation facilities is tocontinue indefinitely anyway.

The word sustainability would be a bit more thanjust a new slogan, if the cost recovery conceptwould be introduced innovatively and effectivelyin the future programmes. Otherwise it would bebetter to omit the whole word in thedocumentation, and say goodbye to replicability.

The recominendations by the author to iinprove theconditions in sariitation sector regardingexternally supported programmes:

1. Promote female education and autonomy.2. Introduce legislation on environmental

sanitation.3. Carry out market survey on environinental

sanitation.4. Create dialogue between all parties involved

in the community development.5. Create inarket through coininunication/social

marketing/hygiene education.6. Satìsfy deuiand on the xnarket for improved

facilities.7. Support community activities and provide

correct external assistance bearing in inindsustainability and replicability.

8. Subsidize/provide ONLY schools and healthinstitutions with sanitation facilities whenrequested by them.

9. Stre]rigthen the local organizations(also those at grass—root level).

49

10. Coordinate and cooperate with other externalagencies, and host institutions.

11. Continue communication/hygiene education witha special focus on potential roles of women,and DISPOSAL OF CHILDRENS FAECAL MATTER.

12. Enfarce legislation on environmentalsariitation.

13. Eval,uate and revise your actions as needed.14. Use systematically applied research in the

sector projects.

There was a man living in a certainvillage, whose son was working inLusaka. His son came to visit hiìu andbrought him a gift: a new shirt andtrousers. Tlie father thanked himprofusely. Six inonths later the sonreceived a parcel containing the shirtand trousers. The accompanying noteread: Please, the shirt and trousersneed to be washed and inended. I amwaiting for your action, since I havenothing to wear.

50

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Parker, R. ].985. Accounting for the Individual.World Water.

Pickford, J. 1988. Rural Sanitation andDevelopment. Waterlines Vol.6 No.3.

Pillsbury, B., Yacoob, M. and Bourne, P. 1988.What Makes Hygiene Education Successful? WASHTechnical Report No.55. 64 p.

Quratul Ain ßakhteari. 1984. Comniunity Managementfor Sanitation. XIth International Congress forTropical Medicine and Malaria, calgary, Canada.

Razig, M. and AlAzharai, A—S. 1989. Efficiency andCost Containment of Water and Sanitation in Sudan.Water, Engineering and Developinent in Africa. Pre-prints of the l5th WEDCConference, Kano, Nigeria,3—7 April 1989.

Refice Statement. 1988.

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Reynolds, K. and Reynolds, D. 1989. The ChurchsRole as A Non-governinental Organization.Waterlines Vol.7 No.4.

Richardson, I. ].989. Partnerships in Low-çostwater Technology. Waterlines Vol.7 No.4. April1989.

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Rinne, S. ].989. The Negation Selection Model andIts Inipact on The Product Development of AnInvestment Good. Tampere University of TecbnologyPublications 59. Dr. thesis. original in Finnish,Astract in English. Tampere. 96 p.

Roark, P., Raker, J., Buzzard, S. and Cauley, H.1987. Pr.ivatization study of the Village WaterSupply and Sanìtation (VWSS) Project Lesotho. WASHField Report No.215. 113 p.

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Samura, P. 1989. Tombo Water and Sani.tationActivities Review. Water, Engineering andDevelomerit in Africa. Pre-prints of the l5th WEDCConference, Kano, Nigeria, 3—7 April 1989.

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Tillman, R., Tobin, W. and Roark, P. DomesticWater supply and Sanitation in IrrigationProjects. WASHField Report No.237. 42 p.

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World Bank. 1988. Annual Report 1988. Washington,D.C. 207 p.

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RECOMMENDED BACKGROUND READING

Burgers, L., Boot, M. and van Wijk-Sijbesma, C.1988. Hygiene Education in Water Supply andSanitation Progra.aes. Technical Paper No.27. IRCInternational Water and Sanitation Centre. Hague.

Abstract

Based on more than 550 documents, this literaturereview together with the selected and annodatedbibliography gives an overview of currentknowledge and experience in hygiene education incommunity water supply and sanitation projects.The revìew covers a range of documents includingunpublished reports and other inateria]. of limitedaccess. Aspects covered include importance andpurpose of hygiene education, various targetgroups, changing hygiene related behaviour,approaches to hygiene education, organization andcost of programme, manpower and training require,use of audio—visual tool, and school hygieneeducation. A range of abstracts have been includedto facilitate access to information on trends,experience and constraints in hygiene education ìnthe sector.

van Wijk-sijbesina, c. 1985. Participation of Woaenin Water supply and Sanitation.. Roles andRealities. IRC Internatìonal Reference Centre forConununity Water Supply and Sanitation. TechnicalPaper Series 22. Hague. 191 p.

Abstract

A comprehensive review of 775 documents hasindicated many aspects of traditional involvementof women in water supply and sanitation, whichhave iinplications for projects and programmesdesigned to iinprove these provisions. Theirtraditional involvement demonstrates that woinenhave a potential role in such projects which willbenefit both the project and women themselves andwhich will contribute to wider development.Comparison of their actual participation withthese potential roles shows the contribution made

62

by women to planning and design, construction,maintenance and management of iinproved watersupply arid sanitation and to health education, anddenotes areas for further development andresearch.

Boot, M. and Heijnen, H. 1988. ren Years ofExperience. Coiiaunity Water Supply and SanitationProgra1Lae, Pokhara, Western Developlkent Region,Nepal. Technical Paper No.26. IRC InternationalWater anc5l Sanitation Centre. Hague. 104 p.

Abstract

The developinent and achievements over a ten—yearperiod of the Community Water Supply andSanitation Programme, Pokhara, in hill areas ofthe Western Region are documented. The programmeconcerns gravity fed water supply schemes withpublic tapstands, and school and householdlatrines. It is a joint effort of four parties:rural communities, the Nepali Government, anddonor orqanizations tJNICEF and SATA/Helvetas.

Programma developments are traced from initialfocus on standardization of design and procedureswith duE attention to manpower training andrecruitmant. Over the ten—year period the emphasishas changed increasingly to promotion ofsanitation and maintenance with due attention torehabilitation of coinpleted schemes. More recentlypersonal and environinental health have beenpromoted as a means tq increase the benefits ofnew water supplies. Experience in this communitybased, low—cost programme shows how the conunittedeffort of aii parties has made steady andsustained progress in building and extending theprogramme.

Briscoe, J. and deFerranti, D. 1988. Water forRura]. Coaiiunities: Helping People Help The~se1ves.The World Bank. Washington, D.C. 32p.

Abstract

Efforts to improve the water supplies used by

63

peopie in rural areas in developing countries haverun into serious obstacles; not only are publicfunds not availabie tc~ builð facilities for all,but many newly constructed facilities have fallenirito disrepair and disuse. Along with the numerousfaiiures there are also successes in this sector.From these successes a new view has begun toemerge of what the guiding principles of ruralwater supply strategies should be.

This book brings together and speils out theconstituents of this einerging view. The centralmessage is that it is the local people theinselves,not those trying to help them, who have the mostiniportant role to play. The conununity itself mustbe the primary decisioninaker, the priinaryinvestor, the prii~ary organizer, and the primaryoverseer. The authors examine the implications ofthis primary principle for the inain policy issues-the level of service to be provided in differentsettings, the level and mechanisins for costrecovery, the roles for the private and publicsectors, and the role of women.

.