Early feedback from a latrine intervention: lessons to inform course correction

Transcription

1 Early feedback from a latrine intervention: lessons to inform course correction Faruqe Hussain Research Investigator WASH Research Group Centre for Communicable Diseases (CCD), icddr,b Water and Health Conference University of North Carolina 16 October 2013

2 Background WASH Benefits Study ( a randomized controlled trial single and combined WASH interventions impact on child health under two years old rural Kenya and Bangladesh Formative work and piloting Small scale in 3 communities Selected latrine model Informed intervention roll out for the RCT 2

3 Background Latrine interventions face numerous problems Appropriate latrine options Generating demand Technology acceptance Supplying durable components Recruiting skilled workers Poor quality slab: without metal wires (no reinforcement) 3

4 Objectives To provide early feedback from an outset of ongoing implementation To guide further implementation To ensure standardized intervention delivery 4

5 Study site and population Two sub-districts Rural population Varied demography 422 households randomly selected clusters Implementation period Feedback data August 2012 to January

6 Distribution of clusters Cluster = ~8 households with a pregnant woman 6

7 Distribution of listed households in a cluster 7

8 Latrine coverage at compound Index Household Neighboring household Courtyard Neighboring household Neighboring household 8

9 Examples: unimproved and unhygienic Latrine with concrete slab, no water seal Latrine with concrete slab, broken pit 9

10 Eligibility to receive a latrine or upgrade New latrine: No latrine access Unimproved latrine Shared improved latrine More than 6 members Latrine upgrade: Visible feces around the latrine (fecal contamination) No/broken water seal Improved latrine but unhygienic 10

11 Latrine assessment Fecal contamination: Improved or unimproved latrines and pits People break pit liner Excreta leaks from pits Fullness of pits is unknown Superstructure Latrine pit 11

12 Latrine assessment Fecal contamination: Improved or unimproved latrines and pits People break pit liner Excreta leaks from pits Fullness of pits is unknown Fecal contamination 12

13 Study provided latrine components Sub-structure ($~35) 2 nd pit Superstructure ($~32) 4 bamboo poles Wooden frame 2 pits with 10 cement rings 5 feet deep 1 concrete slab Corrugated iron sheets for plastic pan & siphon 3 walls, 1 door, 1 ceiling 1 concrete lid in additional pit 13

14 Shared responsibility Household ($~18) Transport sub-structure and superstructure Dig two pits Install sub-structure hardware Project ($70) Free provision of latrine Provide durable product (hiring local masons) Supervise pit digging and installation Provide superstructure materials and builder A community meeting 14

15 Documenting process Technical partner Village Education Resources Centre (VERC) 32-member field team 9 Engineers 22 Field research staff 1 Accountant 2-weekly field meetings (N=12) Quality assurance activities Monthly progress and planning meetings (N=6) Informal discussions with participants 15

16 Implementation problems Contextual/physical Social Economic Latrine near surface water body 16

17 Contextual/physical problems Cannot maintain the recommended distance (10m) between latrine pit and drinking water sources Limited space Tube-well is permanent in a common place Prioritize proximity to water source over latrine Drinking water source and latrine 17

18 Contextual/physical problems Location of latrine Backyard/bush Near surface water bodies High water table Water body around households (ponds, lakes) Physical distance Producers are Bazar/market area-based Households and production centers Impacts transport costs, transportation difficulties 18

19 Contextual/physical problems Water bodies (ponds) around households 19

20 Social problems Households relocate (index and non-index) Build new houses (during pit digging, after installation) Move to parent s during child birth, after divorce or husband s death, husband abroad Household conflict, separation, nuclear family Limits access to latrine Latrine ownership Expectation for a latrine Have well structured Improved and hygienic latrine Latrine in outside for male and seasonal workers 20

21 Economic problems Unable to manage transport cost Poorer households Households with elderly people only Price variability Supply of raw materials in off-season Sand and bricks Price hikes Gas/fuel Transportation cost 21

22 Advantages and disadvantages of producer categories Characteristics Small scale Large Knowledge, expertise, adoption skill High Low Financial motivation Wage + profit Profit Commitment on quality Support needed Committed Technical AND Financial Compromising Technical 22

23 Action points Problems Relocation Implication Actions Latrine assessment Include new households Explain eligibility Exclude older households Explain reasons Wait until relocation Future relocation plan Regular follow up Water table Temporarily high Find alternative latrine location Temporary pit fill up with water Resulted in 3 month delay 23

24 Example: decision matrix Problems/issues Areas Access by CHP* Homestead type Decision/Eligibility Beyond N/A Ineligible Outside the Single HH Eligible village Within Compound Eligible (include Index women's relocation to N/A neighbors) another living Neighbors in Ineligible place Within the older location village Within Single HH Eligible Compound Eligible (include neighbors) *Community Health Promoter 24

25 Lessons learned Community meeting is the main platform to discuss eligibility and expectations Relocation of households (index/non-index) is a social reality and will recur throughout study period Maintaining recommended distance between drinking water sources and latrine is not possible Consider transportation subsidy for poorer households to prevent exclusion Contract small local latrine manufacturer and provide support to ensure high quality latrine components 25

26 Lessons learned Listing implementation problems and discussing with field team provided options for solutions Identifying solutions early in implementation helped course correction for subsequent intervention 26

27 Conclusions Assessing each household latrine helps determining appropriate intervention needed Technical support partner understands the significance of problems Time spent on pre-intervention is essential for scaling up a large-scale intervention 27

28 Acknowledgements Intervention households and local community members Latrine component producers and workers icddr,b, colleagues, international collaborators and coauthors Stephen Luby, Leanne Unicomb, Peter Winch, Elli Leontsini, Mahbubur Rahman, Golam Kibria, Ruhul Amin, Thomas Clasen Diana DiasGranados, Carrie Read Technical partner VERC (Village Education Resources Center) Masud Hassan, Engr. Mominul Islam, Md. Rashid Bill & Melinda Gates foundation 28

29 Latrine cost Activities Household cost (BDT/USD) Latrine materials Project cost (BDT/USD) Pit digging (2) 600 ($7.60) 10 rings 2000 ($ 25.5) Substructure 500 ($6.34) 1 slab+ pan 325 ($4) transportation Installation 200 $(2.5) 1 lid 250 ($3.2) Superstructure 100 $(1.3) 1 plastic pan 54 ($0.6) transportation 1 siphon 70 ($.90) Bamboo pole (4) 300 ($3.8) Superstructure 2700 ($35) materials Superstructure 400 ($5.10) building Accessories 50 ($0.65) Total 1400 ($~18) 6150 ($78) 29