Culture and the health transition: Understanding sanitation behaviour in rural north India

Culture and the health transition: Understanding sanitation behaviour in rural north India, April 2015. International Growth Centre (ICG) Working Paper.

Authors: Diane Coffey, Aashish Gupta, Payal Hathi, Dean Spears, Nikhil Srivastav, and Sangita Vyas.

Key Facts

  • Poor sanitation spreads bacterial, viral, and parasitic infections including diarrhoea, polio, cholera, and hookworm. Despite this, 70% of rural Indian households defecate in the open, without a toilet
    or latrine. Over 60% of the people worldwide who defecate in the open live in India. Bangladesh, which shares a border with India, has a rural open defecation rate of only 5%.
  • Based on a survey of around 3,200 households, and 100 in-depth interviews, this research finds that having a household latrine is widely seen to damage the purity of the home. Open defecation, on
    the other hand, is widely seen to promote purity and strength, and is also associated with health and longevity.
  • A further reason for particularly poor hygiene in Indian public spaces is due to the ongoing renegotiation of caste-based social rules. Most Hindus remain inflexibly opposed to emptying their own latrine pits. As part of a push for greater equality, people from the lowest “untouchable” castes resist emptying latrine pits because this work is widely seen as degrading and reinforcing of their low social status.

Water and sanitation in health centres in Mali – podcast

Water and sanitation in health centres in Mali – podcast | Source: The Guardian, April 28, 2015 |

Lucy Lamble presents this edition of the Global development podcast, looking at how the lack of water and sanitation is affecting health centres in Mali. Just 20% of the country’s health facilities provide clean water.

Photo from WaterAid

Photo from WaterAid

She visits Diatoula, 15km south-east of Bamako, a community of 1,000 people which has one health centre, and hears from Nurse Vinima Baya about how they cope with the lack of water within the facility, with patients and their families gathering buckets of water from the village well.

At Kalabancoro town on the outskirts of Bamako, Lucy visits a clinic opened in 2013, which has done much to improve healthcare for local residents – but where staff still have to buy safe drinking water or ask patients to bring it in.

We hear from experts including Mamadou Diarafa Diallo, WaterAid’s country representative in Mali, and Maggie Montgomery, from WHO’s Water, Sanitation and Health unit, on the problems the country faces in improving access to safe water.

Health workers must have #safeHANDS – WHO annual call to action

WHO #safeHANDS poster

This year’s annual day to recognize hand hygiene among health workers commemorates ten years of the Clean Care is Safer Care programme (2005-2015) of the World Health Organization (WHO).

Hand hygiene is an important element of infection prevention and control. A recent WHO/UNICEF survey of  66,000 health facilities in developing countries revealed that over a third of them lacked soap for hand washing.

To join the campaign and learn more visit: http://www.who.int/gpsc/5may/en/

Webinar: Healing Hands, 5 May 2015, 3:00 PM – 4:00 PM CEST

Hear from experts from WHO, the London School of Hygiene and Tropical Medicine, and Johns Hopkins University on the importance of hand hygiene, the current state of practices and lessons learned from the recent West Africa Ebola Outbreak.

To join the discussion register at the site of the Global Public-Private Partnership for Handwashing.

Infant and Young Child Faeces Management: Potential enabling products for their hygienic collection, transport, and disposal in Cambodia

Infant and Young Child Faeces Management: Potential enabling products for their hygienic collection, transport, and disposal in Cambodia, 2015. WaterSHED; London School of Tropical Medicine and Hygiene.

Authors: Molly Miller-Petrie, Lindsay Voigt, Lyn McLennan, Sandy Cairncross, Marion Jenkins

Background – Despite evidence that children’s faeces play a major role in diarrheal disease transmission through the contamination of the household environment, relatively little priority has been given to research and interventions in this area. In Cambodia, only 20% of children’s faeces were disposed of in an improved sanitation facility according to the 2010 Demographic and Health Survey. This study explores current practices and the role that enabling products may play in increasing hygienic management practices.

Methods – A household survey was conducted in 130 houses in 21 villages and two provinces in Cambodia. Four focus group discussions were conducted, two in each province. Households were restricted to those with an improved sanitation facility and at least one child under five. Results were analysed using STATA13 and explanatory variables were tested individually and using logistic regression to control for child age. Focus group results were analysed qualitatively.

Results – Main place of defecation, method of moving faeces, and main place of disposal differed depending on child age, with children under two least likely to have their faeces disposed of hygienically. Overall, 62.7% of households reported using a hygienic main disposal site while 35.7% reported doing so consistently. Factors associated with hygienic disposal included the number of years a household had owned a latrine, the age of the caregiver, the consistency of adult latrine use, and the presence of tools for child faeces management in the latrine.

Discussion – The results demonstrate a need for interventions targeting the hygienic management of faeces of children under five in Cambodia, and particularly for children under two. The technologies most likely to facilitate hygienic disposal for these age ranges include reusable diapers, potties, and potentially latrine seats. Design features should ensure child safety, time-savings, cost-savings, ease of disposal, and ease of cleaning. Product marketing will also need to address hygiene behaviours related to child cleaning and caretaker hand washing to ensure reduction of disease transmission.

Water and Health Conference 2015: Where Science Meets Policy: Abstract and side event proposal deadline extended to May 1

Abstract and side event proposal deadline extended to May 1
Water and Health Conference: Where Science Meets Policy
October 26-30, 2015
The University of North Carolina at Chapel Hill
The deadline for abstracts and side event proposals for the UNC Water and Health Conference is extended to Friday, May 1.   Submissions should align with this year’s themes: UNC_insert unit.EDITABLE

  • WaSH for the future: SDGs, innovation, resources, integration, and urbanization;
  • Hygiene and behavior;
  • WaSH in emergencies and outbreaks;
  • Learning from practice: MEL, action research, case studies;
  • Water supply and quality;
  • Sanitation: protecting households, communities and environment
More information about the Conference is online at waterinstitute.unc.edu/waterandhealth.

WaterAid – How to sell toilets: a new approach to sanitation marketing in South East Asia

WaterAid – How to sell toilets: a new approach to sanitation marketing in South East Asia | Source: WaterAid Blog, April 22, 2015.

In Cambodia, an organisation named WaterSHED has developed a successful approach to marketing sanitation to remote communities which has reached 40% of Cambodians and is spreading fast across the Mekong region.

Excerpts: Established in 2010, WaterSHED – Water, Sanitation and Hygiene Enterprise Development – is a business development services provider working to bring effective and affordable water and sanitation products to the market, focusing on Laos, Vietnam and Cambodia. Only 28% of people in Cambodia are estimated to have access to sanitation – less in rural areas – and communities and businesses are not always interested in improving this or able to make change happen.

Local supplier with samples of toilet components. Photo: WaterAid/ Erik Harvey.

Local supplier with samples of toilet components. Photo: WaterAid/ Erik Harvey.

Although several organisations in the country were working on sanitation when WaterSHED was established, there was little coherence in their approaches, which Geoff Revell, Regional Programme Manager for WaterSHED, found frustrating. “While on one hand, there is space to try out new things, on the other, there are various approaches, some of which are subsidy driven, that are not very effective.”

A ‘hands-off’ approach

WaterSHED takes a ‘hands-off’ approach, using community leaders to generate demand for sanitation, working with the supply chain to offer appropriate and affordable products and identifying incentives to increase take-up. The organisation encourages businesses to consider adopting sanitation-related products that would complement other aspects of their wider business and thus enable them to diversify. It believes its role as a ‘market facilitator’ is finite, and that exit strategies need to be in place to enable private and public sector players to take over.

The sanitation marketing approach has six key components:

  • Identify community leaders to make the pitch for sanitation.
    Generate demand for toilets using a combination of pride and disgust messages.
  • Link communities to supply chains and vice versa, focusing on home delivery, affordability and promotional models.
  • Enable suppliers to be reliable and trustworthy, offering good-quality products, information and advice.
  • Make links to micro-financing where appropriate.
  • Help identify appropriate and adaptable incentives.

Read the complete article

May 11, 2015 – Sustainability and Value for Money – Using Data to Improve the Performance of WASH Investments

Invitation to attend the Sustainability and Value for Money – Using Data to Improve the Performance of WASH Investments

  • Where: Manson Lecture Theatre, LSHTM, Keppel Street, London WC1E 7HT.
  • When: 5:30 – 8:30 PM on 11th of May 2015, including a drinks reception

The VFM-WASH consortium is delighted to invite you to attend an international seminar on WASH programmes’ sustainability and Value for Money (VFM). The DFID-funded consortium is led by Oxford Policy Management and includes the London School of Hygiene & Tropical Medicine, the University of Leeds, Oxfam and Trémolet Consultingshare

This event, co-convened by the SHARE Research Consortium, will present evidence collected by the consortium over the past two years on the sustainability and VFM of DFID WASH sector investments in Bangladesh, Ethiopia, Mozambique, Nigeria, Pakistan and Zambia. It will also present the findings from surveys of the operational sustainability of WASH services carried out in Ethiopia, Mozambique, Pakistan and Bangladesh.

These findings provide case studies of how VFM analysis can be used to feed into the strengthening of programme management systems.