Each year two million children die from diarrhoeal diseases, making it the second most serious killer of children under the age of five. The main source of diarrhoeal infection is human excreta. It seems clear therefore, that human excreta should be managed as a potentially dangerous material. The construction of latrines is a relatively simple technology that may be used to control the spread of infectious diseases.
Studies have shown that latrine coverage has to reach 90% of a population to have an impact on community health. In Maharashtra, 85% of rural households and 54% of all households have no access at all to a toilet facility. While the Indian government is making great strides in the availability of toilets, this programme looks to increase advocacy and education necessary to convince people to use the toilets, and to create separate male and female toilets in schools together with hand-washing facilities.
It is important to gain political support and government commitment to the programme. A mix of mass media and interpersonal communication is the best way to deliver the key programme messages. Demonstration sites for the selected technologies are important, as is the training of local people in operation and maintenance methods. It is also necessary to provide reasonable funding options and incentives to make the technology affordable. Intended Results: Latrine facilities, separate for boys and girls, with a hand-washing facility will be established in all schools.
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A latrine promotion programme will teach students and the local people about why and how to use the latrines through community involvement, radio messages, and other social marketing strategies. The construction of this latrine system in schools will be used to control the spread of infectious diseases, and promote toilet usage at a young age to school children to convey proper usage and knowledge at home.
Programme Management and Implementation
This programme has numerous phases of implementation.
- Background Data: The first step is to become familiar with the local area and school systems. The acceptance of latrines varies from culture to culture and it is important to understand where the areas of potential resistance lie so as to direct promotion efforts efficiently. Conducting interviews can help to determine users likes and dislikes as well as identify current hygiene practices. This information is essential to the planning of a sanitation promotion program that will match the customs and attitudes of the users.
- Planning Phase: The information gathered during the background study of the local people can be used to plan a custom tailored sanitation promotion program. The initial lanning phase should consist of selection of the key messages to be promoted and a matching appropriate technology. The key messages need to be based on existing ideas, because it is much harder to introduce radical or rapid changes in a population. The core ideas should be kept simple and to the point. It is easiest for people to grasp a few straightforward ideas, rather than a long list of suggested improvements. The type of latrine selected should be low-cost, appropriate for the geographic area, and match with existing customs of anal cleaning and defecation habits as much as possible.
Once the key messages and technology have been selected a marketing approach must be developed. Recent efforts in promotion programs related to socio-cultural issues have focused on social marketing techniques. Social marketing uses the approaches of economics to advance social change. Social marketing advocates a demand driven approach to sanitation. Therefore, a successful sanitation program needs to create a demand for latrines. This is accomplished by offering affordable technology, but also by increasing the social desirability of latrines.
Studies have shown that the reasons people want latrines are less for health concerns than for social status, privacy, comfort and convenience (WHO, 2000). It should therefore, be the goal of any sanitation program to foster these feelings to increase the social demand for latrines. Since social status is one of the driving factors in latrine demand, it is important to recruit prominent people and community leaders to the cause of sanitation. Sanitation promotion by these leaders will increase the acceptability of latrines (Ikin, 1994).
While the role of community leaders may be important, so is the participation of the average community member. Community based efforts have been shown to be more effective than external intervention (WHO, 2000). The marketing approach must select key populations within the community to act as agents of change and use appropriate channels of communication to reach the target audience. Implementation: Implementing a latrine promotion program requires outreach and education of the masses, as well as, cost reduction strategies. It is also important to consider the interactions of any institutions involved in the project schools, government, and construction company) and the issue of sustainability. The most effective method of outreach is person-to-person visits (UNICEF, 2002). These visits are used to share hygiene and technical information, as well as encourage sanitary behaviour changes. Other methods, such as radio and television programming, discussion groups, and school curriculum's, may be incorporated depending on the community reception of these types of media. Radio or television programming has worked well in areas with high coverage by these media. Broadcast programming is most effective when done in the native language.
Discussion groups are a good way to encourage community participation in the project. They may also be a way to disperse technical information to a large population through demonstration sites. Introducing hygiene curriculum in the local schools works well in areas of high school attendance and reliable school systems. Children can act as powerful agents of change when they practice proper hygienic behaviours in the classroom and then bring these behaviours home with them (UNICEF, 2002). It is also hoped that children will retain these positive traits into adulthood.
A significant factor to consider in any sanitation program is the cost to the new technology. High cost is the number one deterrent for the spread of latrine construction (Cotton, 1998). It is important to select low-cost technologies for sanitation projects in the developing world. Many sanitation promotion programs rely on the support of both the local government and NGO. Whenever there are multiple institutions working together on a project it is important to have a clear structure of goals and methods of implementation. Care must be taken not to duplicate efforts or damage the working relationship between the partner institutions.
Where large institutions are involved it is helpful to establish community contacts to ensure effective communication from the field to the institute headquarters. Although the introduction of improved sanitation services may be difficult, ensuring the sustainability of these services may be even more so. The most important step towards sustainability is the involvement of the community from the start of the project. People, students, and the school must learn to take ownership and pride in their latrines. Social marketing strategies can aid in the increased acceptance and demand for latrines.
School programming is also an important step towards educating the future of sanitary behaviour. Another tactic is to train local artisans to construct and maintain latrines. These artisans may build small businesses to market their skills, thus increasing the economy drive behind latrine use. Above all the program must be adaptable and flexible enough to change with the needs and demands of the people being served. Programme Monitoring and Evaluation: Programme monitoring and evaluation will occur to oversee the instalment of toilets in schools, how many children are using the toilets, and possible reasons for not using the toilets.
Community attitudes will also be monitored and surveys will be conducted to see if toilet usage increases in surrounding school communities. Learning and Dissemination: Related Resources: Sanitation and hygiene promotion programs started in India in the 1980s with the support of UNICEF. The initial emphasis was on technical solutions, specifically the promotion of twin-pit pour-flush latrines. The government and UNICEF advocated the construction of these latrines as the national standard for cost-effective sanitation. However, the idea was never widely accepted and latrine coverage in rural areas remained less than 10 percent.
The cost of latrine construction was considered too high and people saw little motivation for use. Between 1986-1987, UNICEF performed several micro-field studies to determine alternative methods to sanitation promotion. The results indicated that the lack of community involvement was detrimentally to the program. The studies also revealed several reasons behind people’s reluctance to use the new latrines. People avoided latrine use for fear of breaking it, or because they believed it more sanitary to defecate in the fields away from the house, or because they preferred to use the latrine as a storage facility.
The high cost of the twin-pit pour-flush toilets was also often beyond the means of many poor communities. The results of these studies lead to a new approach in sanitation promotion in India in the 1990s. The new emphasis was on lower-cost latrines and sanitary behaviour changes. A community-based approach was used to promote behaviour change. Efforts were made to increase household visits, school programming and considerations for gender issues. Sanitation issues were linked with other health concerns in an attempt to increase motivation for latrine usage.
A program evaluation in the mid 1990s indicated that person-to-person visited could be highly effective, but that 3-4 visits were required for every latrine installed. The labour costs associated with this method of promotion are therefore quite high. School programs were developed to teach children hygienic behaviours, including the use of a latrine. The hope is that the children will than bring these behaviours home with them, thereby acting as agents of change in their communities. The new promotion plan also stressed the role of women in sanitation and household hygiene management.
Lack of proper sanitation facilities has traditionally been more detrimental to women than to men. Due to the lack of privacy, many women may wait until nightfall to relieve themselves, leading to serious health problems and kidney failure. The lack of sanitation facilities has also been a barrier to girls attending school. The restructuring of the sanitation promotion program has attempted to address these issues by including women in health discussions and the operation and maintenance of the new latrines. The key to sanitation promotion in India has been balancing the technical and social aspects of sanitation services.
Since the introduction of community based promotion methods, rural India has seen sanitation coverage increase from nearly zero to 14% while total sanitation coverage increased to 31%. Community involvement and self-financing methods lead to the construction of more than 350,000 latrines in one county alone. An impact evaluation in 1999 showed consistently better excreta disposal practices in communities participating in the promotion programs. The study indicated that future sanitation promotion efforts should focus on social marketing techniques and community management of latrines.
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