by Paul Dean.
Providing a clean water supply and encouraging people to build latrines should surely be enough to ensure good health. In the past people have certainly believed this to be true. However, an evaluation of a water and sanitation programme by the Ministry of Health in Botswana (UNICEF), though it brought many positive benefits, included these interesting results…
- Water that was clean at source was highly contaminated by the time it was consumed in the home.
- Households adopting VIP latrines (see article 'Planning a Pit Latrine') still had a high incidence of diarrhoea.
- Approximately 75% of men with latrines in their compound still urinated in the bush.
- Approximately 75% of children with latrines in their compound did not use the latrine.
It was then discovered that nearly 85% of the households which had built VIP latrines had received no health education information either before, during or after construction. This may help to explain some of these results.
The bicycle in the latrine
Several studies report latrines being used as stores for food, bicycles or other things, rather than as toilets. This may be because there was no advice about how and why to use the latrine when built, just like the project in Botswana above. Much of the money and energy put into the project, by community members as well as the project team, will have been wasted.
Few people would let a child use a bicycle without first finding out if they could ride it. If I give something to somebody I usually make sure that they know how to use it first – if not, I would teach them.
Understanding why
But that may not be enough either. Sometimes it’s important to know why we have to do something, as well as how to do it. This is especially important when it is difficult to link the results of our actions with their cause.
Understanding that my faeces contain substances that can harm me and those around me, and that I need to dispose of them carefully and wash my hands straight afterwards is not obvious.
In the same way, it may be difficult to understand why I have to clean out the container I collect my water in, why I should not drink from the cup I use to draw water out of the pot, and why I should cover the pot when not in use. The water does not look any different, even if I don’t do all these things.
So knowledge is not always sufficient to solve a problem. It needs to result in a change in practice too, which usually first requires a change in attitude to the situation.
The cycle of infection
The UNICEF figures quoted in the article 'The three legs' in this issue, show the importance of sanitation and hygiene in breaking the cycle of infection. This is because many of the infections that cause diarrhoea are related to poor sanitation and hygiene behaviour.
The diagram below shows the main ways in which disease is passed from an infected person to a new host. Sanitary disposal of faeces, hand washing after defecation and before handling food and drinking water are therefore very important activities.
Diarrhoea, dysentery, typhoid, many kinds of intestinal worms, bilharzia, scabies, typhus and trachoma (eye infection) can all be reduced through improving personal hygiene and sanitation. Activities to improve these behaviour patterns should be part of any water and sanitation programme.
Local priorities
But social, cultural and economic conditions may result in people having other priorities which make it hard for them to change their attitudes and practices. Like so many other development activities, hygiene education should be relevant and realistic. It should not be limited just to providing information and promotion of latrines and hand washing. It is important to make sure that education is relevant to people’s local concerns and resources.
Discussing how defecating or urinating into or close to water can transmit bilharzia will only be relevant in areas where bilharzia is a concern. Preventing small quantities of water lying around the house in tin cans, tyres and jars can control the breeding of mosquitoes which carry dengue fever – but only in areas where these mosquitoes exist!
Hand washing
Washing hands after using the latrine will be difficult if water is scarce. The use of a ‘Mukombe’ (Footsteps 14) or ‘Tippy Tap’ (see article) may help. If no soap or wood ash is available, it has been shown that simply rubbing your hands in soil before washing them is better than just rinsing them in water. Improving water quality by boiling is difficult if time and fuel are in short supply. For most needs, a simple three-pot system or exposure to sunlight (Footsteps 1) could be adequate.
Water containers
People should be encouraged to scrub and rinse water containers with clean water before refilling. Drinking water should be stored in covered jars in the home, using a cup on a handle or a long handled dipper to collect the water. This will prevent fingers touching and contaminating the water. People should never drink directly from the dipper.
Involving everyone
Programmes must also be participatory. This will allow everyone to talk through the problems, priorities and possibilities that exist and allow programme workers to find out local priorities, practices and preferences. It may mean holding meetings and education activities to fit in with local work patterns, farming practices or social activities, rather than for the convenience of programme staff. For example, in some countries the poorest people are often landless and have to farm the land of others to earn money. They could therefore miss community meetings and be further marginalised if meeting times are not chosen carefully.
Above all, everything should be designed to meet the local situation and result in appropriate changes in practice.
Paul Dean worked for seven years in Uganda with Tearfund and is now a consultant in Rural Infrastructure and Civil Engineering.