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• (Article) Beyond ‘functionality’ of handpump-supplied rural water services in developing countries

  01.01.2016
  Many rural point-water sources in developing countries consist of wells or boreholes equipped with handpumps. Various estimates have been made of the functionality of such water points, and functionality is now routinely monitored in national and local surveys of service performance. We argue, however, that a single binary (functional/non-functional) indicator is crude and insufficient to provide much information about service sustainability. We set out a categorization of functionality which includes three sub-categories of functional water points and five non-functional sub-categories, with well/handpump water points in mind. We use a simple model to demonstrate that reduction of high rates of early post-construction abandonment and reduction of total downtimes would greatly improve service performance. We show that functionality levels for multi-age populations of wells or boreholes equipped with handpumps would not normally be expected to exceed about 85 per cent. We recommend going beyond functionality monitoring via the collection of quantitative data on rates of abandonment, frequency and duration of breakdown, combined with descriptive narratives of actions to manage and repair water points, in order to generate more nuanced understanding of service performance.

• (Article) The role of handpump corrosion in the contamination and failure of rural water supplies

  01.01.2016
  There has been much discussion over many years regarding the origin of elevated iron concentrations in rural water supplies in sub-Saharan Africa and Asia. High iron concentrations are often assumed to be naturally occurring in groundwater, despite several studies over the last 30 years which also point to the role of handpump corrosion in aggressive groundwater. Handpump standards specify that galvanized iron pump materials should not be used in groundwater due to the risk of corrosion, yet this advice is not always followed. High iron concentrations, whether naturally occurring, or present as a result of corrosion, have an impact on taste, odour, and appearance of water and can promote the growth of unpleasant iron metabolizing bacteria. These effects often result in the abandonment of boreholes, sometimes only a year old, and a return to unprotected and unsafe water sources. Where boreholes are not abandoned, the effects of corrosion can cause pump materials to degrade to the point where the pump becomes inoperable. These outcomes are clearly inconsistent with the provision of sustainable water supply services as a fundamental human right. This paper provides a synthesis of work undertaken in this area over the last 30 years and recent practical experience of WaterAid in investigating these problems in water supplies in north-eastern Uganda.

• (Article) Schoolgirls’ experiences of changing and disposal of menstrual hygiene items and inferences for WASH in schools

  01.10.2015
  Menstrual hygiene management (MHM) challenges during changing and disposal of menstrual items are important in low-income countries (LICs) where schools lack sufficient water and sanitation. Changing in poorly maintained latrines may expose girls to excrement and infection. We examine the frequency of dropping menstrual items and disposal of waste by schoolgirls in a menstrual solutions feasibility study in western Kenya. Drops when changing were reported in 17 per cent (20 per cent <16 years; 16.5 per cent 16 years plus; p=0.04) of girls’ reports overall. Differences by socio-economic status were not evident. Fifty-four per cent of girls dropped at least once. A quarter of girls using pads and cups reported drops in the first few months, reducing to 10 per cent over time, compared with ~30 per cent among traditional item users. One in four accidental drops occurred at school during the study. When dropped at school, most girls swapped the dropped item for a new one, but 24 per cent brushed/washed the item and reused it. While no clinical events occurred during this study, data suggest dropping within latrines could place girls at potential risk of exposure to infection. Disposal of items, or emptying cups, was mostly into the latrine. We conclude that accidental dropping of menstrual items while changing is common, including at school. Prevention will be helped by improving poorly constructed sanitation facilities, shelving, privacy, and staggering/increasing break time for girls to change. Provision of special garbage bins to prevent clogging and overflow of latrines is recommended.

• (Article) Intensifying the social performance and sustainability of microfinance institutions to address the social challenge of sanitation: an Indian case study

  01.10.2015
  The microfinance model has helped to address the world’s social challenges to some extent. Sanitation is one of the world’s social challenges and microfinance can be used as an intervention tool to address this. Worldwide 1.04 billion people still practise open defecation, accounting for 15 per cent of the world population, and of which 594 million are Indians. To address this sanitation problem, Bharathi Women Development Centre (Bharathi), a Tamil Nadu-based non-government organization, used its microfinance programme and group network to educate about the need for toilets, and provided the resources and technical know – how to construct latrines in individual households. So far they have successfully constructed 14,609 toilets by providing microcredit and have experienced no difficulties in repayments of loans, by which it is proved to be a sustainable programme. Bharathi has faced many challenges while implementing this project, such as raising debt fund for on-lending to its sanitation portfolio; shifting the culture of open defecation after construction of toilets, especially with male members of the family; establishing a technical know – how workforce to construct the toilets in rural areas; helping the poorest of the poor to not be burdened by the sanitation loan because of its non-income generating nature; and maintaining the low-cost construction of toilets. This study illustrates how a relatively small NGO microfinance institution was able to create a niche market and implement a sustainable sanitation programme along with its routine microfinance programme by providing awareness, technical assistance, and credit to construct toilets.

• (Article) Small-scale waste-stabilization ponds for rural communities: an undergraduate experimental venture

  01.10.2015
  Though billions of people are without adequate fresh-water resources, even more people lack effective sanitation services. This latter concern is the focus of an appropriate technology initiative (WASTE Programme) of Wheaton College in Illinois which engages undergraduate students and interdisciplinary faculty in experiments with simple, small-scale waste-stabilization ponds for eventual installation in many global communities. Project laboratory data indicate that low-cost, low-maintenance systems can eliminate microbial pathogens and provide nutrient-rich effluent for agricultural use, before recharging the local groundwater.

• (Article) Sanitation and disasters: a case study of community and institutional response to Cyclone Phailin, Odisha 2013

  01.10.2015
  There is a new shift in political interest in sanitation in India with the newly launched Swacha Bharat Abhiyan on 2 October 2014. Given this renewed interest, this paper investigates the specific context of a post-disaster situation and approaches to sanitation using the case study of Odisha, India. Progress in sanitation when juxtaposed with a disaster relief and recovery situation depends upon the socio-economic conditions, community practices in sanitation and hygiene, and political response to sanitation and disasters. This study uses empirical evidence gathered in the aftermath of Cyclone Phailin in 2013. The evidence was collected through focus group discussions with communities, interviews with local non-governmental agencies, and meetings with agencies. The emerging data helps in analysing the strengths and weaknesses of sanitation in the post-disaster context in Odisha, and links the evidence to pre-existing chronic issues including open defecation practice and other socio-economic disparities.

• (Article) Putting heads and hands together to change knowledge and behaviours: Community Health Clubs in Port-au-Prince, Haiti

  01.10.2015
  Although interventions that emphasize the role of knowledge in invoking behaviour change have recently become unpopular, the Community Health Club (CHC) model has demonstrated how group knowledge, consensus building, and peer pressure can be applied to achieve hygiene behaviour change. To date, the model has predominantly been implemented in rural settings, with limited testing in urban communities. In 2012, CHCs started in Haiti as a grassroots initiative, growing from six clubs in six Port-au-Prince communities to 66 clubs across 30 communities in 2015. This paper focuses on the 23 clubs formed between March 2012 and July 2014, when a retrospective process and outcome evaluation was conducted. Using a mixed methods study design, this evaluation used interviews with CHC facilitators and household surveys in three case neighbourhoods to assess how the CHC model was implemented and if differences exist between CHC graduates and non-members. The CHCs have successfully facilitated social bonding, while graduates demonstrated significantly higher preventative WASH knowledge and were seven times less likely to report openly defecating than non-members. However, programmatic and structural factors such as recruitment methods, non-members’ distrust, urban living conditions, and market deficiencies hindered wider uptake of some behavioural changes. These findings inform how the CHC model operates in an urban context.

• (Article) Addressing the behavioural constraints to latrine uptake: effectiveness of a behaviour-change campaign in rural Cambodia

  01.10.2015
  Cambodia has the lowest coverage of improved water and sanitation facilities in South-east Asia. Research suggests that rural Cambodians prefer a high-quality latrine over one provided for free. Market-based approaches are often used to increase sanitation coverage, but private operators lack sufficient incentives and resources to stimulate demand among households that are not immediately responsive to sales events. This study assessed the effectiveness of a Behaviour Change Communications (BCC) intervention designed to address behavioural factors that may limit uptake of latrines. The study applies a quasi-experimental matching technique to estimate the causal effect of the intervention on latrine uptake in rural areas. Communes that received both the BCC intervention and sanitation marketing were matched to similar communes where only sanitation marketing was carried out. Multivariate linear regression analysis is used to estimate the impact of the BCC intervention on latrine uptake. Results show that latrine uptake was slightly higher (0.55%) in BCC communes during the core period of the intervention, but wide variation in sales between communes made it difficult to detect a significant effect. Overall, coverage increased at a faster rate (3%) in BCC communes, but again, these results were not significant. Publicly subsidized sanitation promotion may help to reduce behavioural barriers to latrine adoption. In the absence of alternatives that address the financial constraints of households, such as toilet loans, or in situations where national policy discourages sanitation subsidies, government investment in BCC may be a worthwhile endeavour to strengthen parallel market development efforts, at least until sanitation businesses are well established.

• (Article) Why do some behaviours change more easily than others? Water-use behaviour interventions in rural Nepal

  01.10.2015
  Water-sector development is inevitably based on changes in people’s behaviour. We analyse why some types of domestic water-use behaviours change more easily than others. Our case study is a water supply and sanitation intervention in remote and rural Nepal. We found that collective opportunities, degree of individual freedom, and individual incentives influenced the ease of the promoted behaviour changes. The enhanced individual opportunities, incentives, and collective tolerance enabled behaviour changes that were regarded as beneficial by the people themselves, whereas the existing social traditions in our case-study context often restricted those changes. Often, the individual agency and the collective traditions confronted one another. We suggest that this study can provide a design for predicting possible opportunities and challenges regarding behaviour changes in field operations, and for enhancing joint operation of individual and collective capabilities at local levels in the development intervention context.

• (Article) Strengthening behaviour change communication in western Nepal: how can we do better?

  01.10.2015
  The Government of Nepal aims to achieve full water and sanitation coverage by 2017. The bilateral Rural Water Supply and Sanitation Project in Western Nepal (RWSSP-WN) works with local governments in 14 districts, aiming to declare them open defecation free. This behaviour change communications evaluation explored how to improve RWSSP-WN’s present practices to reach the diverse target population in the Terai districts, where more than 1 million people still defecate in the open. The study reviewed RWSSP-WN’s present behaviour change triggering tools and related communications strategies. Our findings suggest that availability of subsidies seems to change how people think about sanitation and tends to eliminate willingness to pay for a latrine. We recommended strong advocacy for a no-subsidy policy, and more attention paid to alternative financing options with targeted support to the poorest of the poor. The present behaviour change triggering tools do work as intended, but there is a need to develop pre-triggering and post-triggering strategies to increase the overall impact. The pre-triggering strategy would ensure that potential barriers to change are identified and addressed before the actual triggering event, and that the key stakeholders are prepared for the actual triggering event. The post-triggering strategy is needed to continue motivating households to change via messages that tap into the drivers of change, addressing also the barriers which may keep each household from changing behaviour. This paper provides a number of recommendations applicable for those working with local governments and communities to increase the scope and scale of behaviour change triggering.

• (Article) Who is likely to own a latrine in rural areas? Findings from formative research studies

  01.10.2015
  This study examined factors associated with latrine ownership across different formative research studies and the extent to which these may differ among households from the poorest quintiles. Cross-sectional data was collected between 2008 and 2012 from households in rural areas of Tanzania, Indonesia (East Java), and multiple states of India. A framework, SaniFOAM, guided factors theorized to influence latrine ownership. Multivariate analysis was used to build country-specific models predicting latrine ownership. Factors associated with latrine ownership included: satisfaction with the current place of open defecation, perceptions of the adequacy of water and land for latrine ownership, social norms, sanctions and enforcement, and perceived latrine affordability. Emotional, physical and social drivers also showed a significant positive adjusted association with latrine ownership. Apart from one exception, there was no interaction between the behavioural determinants and wealth on latrine ownership. We conclude that understanding the factors which prevent or facilitate the widespread construction of latrines will inform interventions aimed at changing collective behaviour and creating demand for improved sanitation.

• (Article) Measurement of handwashing behaviour in Multiple Indicator Cluster Surveys and Demographic and Health Surveys, 1985–2008

  01.10.2015
  With this paper, we aim to describe handwashing worldwide, as measured in Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) in low- and middle-income countries between 1985 and 2008, and to explain the strengths, weaknesses and evolution of this data collection to inform future survey development. We searched reports of DHS and MICS conducted before 2009 and analysed data on handwashing measurements. We examined data according to geographic region, as well as demographic characteristics such as wealth quintile, education of the household head, and rural/urban location. Before 2009, eight MICS and 40 DHS included handwashing-related measurements, using a variety of self-reports and rapid observations. Internal triangulation of findings from surveys that collected multiple types of measurement shows that self-reports to closed questions overestimate behaviour. Observation-based data suggest low handwashing rates in many low- and middle-income countries with high prevalence of water and sanitation-related diseases, and high inter- and intra-country disparities. However, due to the widely disparate nature of the pre-2009 handwashing-related measurements, much of the data cannot be compared between countries, and only an incomplete picture of global rates can be formed. Efforts to increase the prevalence of handwashing with soap and water need to be strengthened in many low- and middle-income countries, especially among poorer, rural populations and where the household head has less formal education. Closed questions asking for self-reports of handwashing behaviour should be avoided. Findings support instead the inclusion of uniform observation-based measurements, as were integrated as core modules of MICS and DHS in 2009.

• (Article) Handwashing for menstrual hygiene management among primary schoolgirls in rural western Kenya

  01.10.2015
  Good hand hygiene contributes to the health and educational attainment of schoolchildren. Poor menstrual hygiene management (MHM) is recognized to impact on girls’ health, education, wellbeing and dignity, particularly in low-income countries. Identifying practical, affordable, and comfortable menstrual products to improve girls’ MHM is needed. One potential cost-effective product is the menstrual cup; however, provision of this insertable MHM product, in schools in low-income countries with challenging water, sanitation and hygiene (WASH) conditions, increases the need for assurance of good hand hygiene. This paper uses data from a randomized controlled feasibility study evaluating the acceptability, use and safety of menstrual hygiene products provided to schoolgirls in rural western Kenya. Here, we explore girls’ handwashing practices in school when using menstrual cups, sanitary pads or traditional items, examining the availability of WASH and the reported frequency of handwashing. Data generated from interviews with adults, girls’ private surveys, narratives from focus group discussions, and observational WASH surveys are explored. Reported presence of WASH was higher than that observed during random spot-checks. Overall, 10 per cent of girls never washed before, and 7 per cent never washed after, emptying or changing their menstrual item at school. Girls in cup schools were twice as likely to wash prior to emptying, compared with girls using other items. Handwashing among girls using traditional items was low, despite the same hand hygiene training across groups and a comparable WASH presence. Data highlight the need for sustained mechanisms to support schoolgirls’ handwashing practices for MHM.

• (Article) Editorial: What does it take to change behaviour?

  01.10.2015
  

• (Article) Are burial or disposal with garbage safe forms of child faeces disposal? An expert consultation

  01.07.2015
  The importance of safe handling and disposal of child faeces given its potential role in disease transmission are increasingly recognized. Household surveys demonstrate that the burying of child faeces (‘dig-and-bury’) is common in several countries, especially in sub-Saharan Africa and South-east Asia. Disposal with garbage is widely practised in middle- and high-income countries and is becoming increasingly common in urban areas of low-income countries. The safety of these two approaches is difficult to assess given the limited evidence available and we therefore sought the opinion of experts in the field of sanitation to support advocacy around the topic. We report the findings of an anonymous expert (Delphi) consultation on the safety of these two child faeces disposal methods. There was almost unanimous agreement these should be considered neither safe nor improved. A range of arguments was provided to support this position, including proximity of solid waste and burial sites to the home and children’s play areas and that neither practice would be acceptable for adults. The consultation also highlighted gaps in the current evidence base that should be addressed to gain a fuller insight into the risks involved in these two forms of sanitation with a view to providing both programmatic and normative guidance. In particular further work is needed to assess the potential for exposure to faecal matter in solid waste in low- and middle-income countries and to elucidate the predominant practices of child faeces burial including proximity to the home or infant play areas as well as depth of burial.

• (Article) Microfinance for sanitation: what is needed to move to scale?

  01.07.2015
  The sanitation sector is gradually realizing that the effectiveness of approaches such as Community-Led Total Sanitation (CLTS) is limited by inadequate access to finance. Households are not able to construct durable facilities and sanitation services are unable to develop so as to respond to demand. At the same time, there is fierce competition among microfinance services providers that is pushing institutions towards more remote customers and to offer innovative products. In addition, the rise of mobile banking and digital finance has lifted many poor people out of financial exclusion. These factors have created a nexus between microfinance and sanitation with high growth potential. However, the sanitation microfinance market remains small to date. Since 2010, the SHARE research consortium has investigated global experiences and lessons for using microfinance to develop sanitation services. A SHARE action-research in Tanzania triggered selected financial institutions to offer financial products for sanitation and generated lessons for scaling up sanitation microfinance. This article presents the findings from the SHARE research, in the context of broader developments in the microfinance markets and key findings from other donor-led initiatives.

• (Article) Learning, acting, and learning (LAL) research on schools' menstrual hygiene management (MHM): Pakistan

  01.01.2015
  UNICEF Pakistan adopted a conceptual framework for global qualitative research to advance their ongoing exploratory research work on menstrual hygiene management (MHM) in 2013-14. The findings of qualitative research informed the design of certain interventions in schools to improve MHM. These interventions were implemented as action research so that the benefits of these interventions can be studied. Qualitative research gave an in-depth understanding of girls' needs and their preferences to address MHM-related issues. Data analysis of qualitative research helped a team of sanitation practitioners and social scientists in understanding different factors influencing MHM in girls' schools. A few simple and focused interventions were hence designed and implemented. Six weeks after the implementation of hard and soft activities on the ground the results were studied. Results showed significant improvement in MHM conditions in girls' schools. Girls and teachers welcomed the initiatives and there were indicators for future sustainability. Areas of improvement were also noted by UNICEF before taking these interventions to scale. This research was documented as ‘learning, acting, and learning’ (LAL: literally meaning ‘Red’ in the local language, Urdu) research.

• (Article) Towards a sustainable solution for school menstrual hygiene management: cases of Ethiopia, Uganda, South-Sudan, Tanzania, and Zimbabwe

  01.01.2015
  African schoolgirls face considerable challenges as a result of the real biological phenomenon of menstruation and its management. Menstruation is seen as a secret and is regarded as taboo. As a result girls are not receiving adequate support from home, schools, or the community. They are left on their own to address the challenge which consequently affects their school performance. Development interventions that deal only with the supply of materials cannot resolve the problem in a sustainable manner. We need to have a comprehensive approach that can improve: knowledge, attitude, and practice of girls, parents, and the community; sanitary materials supply; the policy environment; and the physical infrastructure. The issue of menstrual hygiene management is gaining recognition as part of the development agenda for improving girls' school participation. But there is little research and few practical case studies have been conducted to inform policy and practice. SNV Netherlands Development Organization is addressing menstrual hygiene under its WASH in School programme in Asia, Africa, and Latin America. This article highlights baseline survey findings of the current menstrual hygiene management practices in the project areas of Ethiopia, South Sudan, Uganda, Tanzania, and Zimbabwe and recommends the approach piloted.

• (Article) Unpacking the policy landscape for menstrual hygiene management: implications for school WASH programmes in India

  01.01.2015
  Menstrual hygiene management (MHM) relates to how girls and women manage their monthly period, and require access to information about menstruation, clean and safe menstrual absorbents, and amenities and facilities such as toilets and water, and waste management to maintain hygiene. In general MHM is poor in India, with low levels of knowledge and many misconceptions, varied use of menstrual absorbents, and unhygienic practices among adolescent girls. With almost 50 per cent of school age girls enrolled in schools, creating a conducive environment in schools to promote MHM is imperative. This policy scoping exercise examines how select policy initiatives implemented by the Government of India address MHM, especially in the context of schools. This document review found that adolescent girls are a focus of most policy initiatives addressing MHM, with a focus primarily on the hardware (i.e. infrastructure, sanitary napkins) or software (i.e. health education) components. Most programmes are implemented at the school level, though guidelines for implementation are not always explicit. Programmes suggest convergence with other government programmes, yet operationalization of convergence mechanisms is lacking.

• (Article) Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia

  01.01.2015
  The onset of menstruation has proven challenging for girls in school, with absenteeism, missed class time, reduced participation, teasing, fear, shame, and risky adaptive behaviours among the most commonly noted impacts in many settings. In 2012, Emory University and UNICEF conducted a multi-country formative study to gain a global perspective of girls' experiences. A compendium of tools was created to ensure investigation of common themes across all settings. This paper describes the process of adapting the focus group discussion (FGD) tool for Bolivia into a board game as a method to ease girls' discomfort discussing menstruation and elicit richer data. We describe the development of the menstrual hygiene management game, including structure and strategies for adapting FGD questions that increased interaction, stimulated detailed responses, and diversified participatory activities. A discussion of lessons learned will highlight elements of success and areas for improvement in future game adaptations. The paper discusses games as a research method for other topics and their applications for programme design, monitoring, and skills-based learning.