Water Sanitation Health

Sanitation challenge: Turning commitment into reality

Getting sanitation and hygiene right

Effective sanitation and hygiene programmes need to combine interventions to change behaviour with the selection of the right technology. Changing behaviour requires culturally sensitive and appropriate health education. People need to understand, in terms meaningful to their lifestyles and existing belief systems, why better health depends on the adoption of hygiene practices such as hand-washing (after defecation, after handling babies’ faeces, and before cooking), on the use of latrines for safe disposal of faeces, and on safe storage and handling of drinking-water and food. Raising awareness of why sanitation and hygiene are important will often increase motivation to change harmful behaviours. Selecting the right sanitation technology is about having effective alternatives and making the right choice for the specific circumstances. Making the right choice of technology requires an assessment of the costs (both for building the facility and for operations and maintenance) and its effectiveness in a specific setting. For example, it is inappropriate to introduce piped sewage if there is no capacity to adequately treat the effluents. The use of conventional sewerage systems in extremely water-short regions may also be unsustainable.

What can we do?

National governments can ensure that hygiene promotion is funded alongside sanitation in a well-balanced programme. This may mean additional central government support for hygiene promotion and sanitation marketing. National governments can also support reviews of technical norms and standards, of planning regulations and of the health impacts associated with different options; fund research into appropriate technologies; and provide incentives for district/local governments to review their own policies and to innovate. Health education, especially concerning sanitation and hygiene, needs to be added to the national school curricula, and effective school sanitation strategies need to be developed.

District/local governments can provide funds for hygiene promotion and sanitation marketing; fund and support local entrepreneurs and public sector agencies that seek to develop new appropriate technologies; review and revise restrictive planning regulations and technical norms; and promote the use of appropriate sanitation facilities.

Communities and civil society can develop their own local technological solutions; make an effort to find ways of working with local technical agencies; be flexible when it comes to balancing local needs (getting the excreta out of the house) with community needs (protecting the communal environment); and participate in hygiene promotion and sanitation marketing campaigns.

Households can adopt good sanitation and hygiene practices; innovate, take action, talk with neighbours about solving local problems; and encourage local political representatives to support locally developed solutions.

Entrepreneurs can invest in research and development; carry out needs assessments and marketing research; find out what people are already using and develop better versions; and develop products and services that comply with national and local legislation and regulations.

International organisations can ensure that external funds for sanitation hardware are bundled with appropriate hygiene promotion and sanitation marketing activities; encourage governments to consider appropriate, cheaper or more effective sanitation technologies; finance local sanitation research; develop guidance and tools for facilitating good practice; disseminate information; and actively endorse the idea of flexible technical norms and standards.

We’re inspired by…

… the PHAST approach
PHAST stands for participatory hygiene and sanitation transformation. It is an approach designed to promote hygiene behaviours, sanitation improvements and community management of water and sanitation facilities using specifically developed participatory techniques. The underlying basis for the PHAST approach is that no lasting change in people’s behaviour will occur without understanding and believing. To summarise the approach, specific participatory activities were developed for community groups to discover for themselves the faecal-oral contamination routes of disease. They then analyse their own hygiene behaviours in the light of this information and plan how to block the contamination routes. PHAST has been successfully field-tested in a number of African countries in both rural and urban settings. The impact on one school in Botswana is presented below.

… PHAST in Botswana
In a school in Botswana, a latrine block had recently been built by the government. Hand-washing facilities were provided, but not soap. Teachers and parents decided that this was not acceptable and created a fund to buy soap dispensers and keep them filled. The majority of parents contributed the small sum necessary to make the improvement. The teachers introduced hand-washing into their teaching, particularly with the youngest pupils, and helped the children to arrange a system of cleaning by rotation to ensure that the latrine blocks stayed clean.

… innovations in Zimbabwe
In Zimbabwe, the ventilated improved pit (VIP) latrine – an indigenously developed technology – became the standard technology for low-cost rural sanitation programmes. The VIP, in a variety of guises, has been instrumental in increasing sanitation coverage in many locations in Africa and Asia. Recent successes with the promotion of simple hygiene interventions through community health clubs have led large numbers of poor households in Zimbabwe to adopt safer hygiene practices and has increased demand for sanitation facilities. This has led to a reassessment of the national approach to sanitation and the widespread adoption of an approach based on hygiene promotion.

... condominial sewers in Latin America
In many Latin American countries, urban households expect to connect to a sewerage system. In congested urban slums, this may be the only option, but sewerage is expensive. In Brazil, an alternative approach was developed more than 20 years ago and is now adopted as standard in many cities and towns. Condominial approaches are cheaper to build and operate than conventional systems but have not expanded into neighbouring Latin American countries as fast as could have been expected. In Bolivia, the intervention of an external support agency (the Swedish International Development Cooperation Agency) and support from the Water and Sanitation Program (WSP) enabled the Government and the private operator in La Paz, El Alto, to experiment with the condominial approach. External support agencies in such cases can provide access to skills (technical or social development skills) and provide funds for activities that perhaps cannot initially be funded from the government’s own programme because the rules and approaches being piloted fall outside the existing government rules and standards.

Sources: WHO, UNDP, WSP (1997). The PHAST initiative: participatory hygiene and sanitation transformation. A new approach to working with communities. Geneva, World Health Organization; Robinson A (2002).
VIP Latrines in Zimbabwe: from local innovation to global sanitation solution. Nairobi, Water and Sanitation Program-Africa Region (Field Note 4 in the Blue Gold Series);
Sidibe M, Curtis V (2002). Hygiene promotion in Burkina Faso and Zimbabwe: new approaches to behaviour change. Nairobi, Water and Sanitation Program-Africa Region (Field Note 7 in the Blue Gold Series); www.wsp.org;
Foster V (undated). Condominial water and sewerage systems – costs of implementation of the model. Vice Ministry of Basic Services (Government of Bolivia), Water and Sanitation Program, Swedish International Development Cooperation Agency.