}~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~c 0 .6 1 Water and Sanitation Mi'.Ii 'LD L8S ThGL@ dLm X8 W Africca Regionr This Field Note describes-experiences in - Approximately 200,000 people in -. - hygienepromotion-intheOromivia Region of Ethopia. hree wter *tt&d~dthe Oromia Region of Ethiopia ' of Ethiopia.- Thiree v.ater projects, aned b from thre gi - n - -, ..-:- -" by WoterAid, have also- impeme4ted - have benefited from three gravity-- hygiene and saiiitation'prorno. j fed water supply and sanitation papprooches which use a variefy of l projects financed by WaterAid and cyhieneo Communicatons, W(ater ad implemented by its local partner, w * Sanitation Commnittees, FocusGraupl* and . Water Action. The schemes are V - --' : , 7Distridt Health Staff) to pass key-messages;. > |- vAd .x - ' Promotional methodologies incJude:' j located at Hitoso and Gonde lteya ' - -demonstrationlatrines,useofparticip9tory 1 inArsi Zone, and Robe Maliyu in a7 on \, tools and practices, media campagigns,.| BaleZone. f J4E'.N. , school visits, house-to-house visits, I Ths area o E . ; - -- and child-to-child hygieneThis area of Ethiopia is The Note -.presents advice' generlly fertile, and both arable recommendationsonthebtsisofthis feld g ryt and both a:r' -. ' . - experience regarding the -use aof .these _ and pastoral farming is practiced. E - approaches for large-scale programs. - Highland springs are a major 0 d ssAbb&a'-. source of water but communities H -; w j d . wM in drier areas at lower elevations ' , - , are often some distance from rivers t- - or wells, involving considerable -- f -- time investment in water collection. /~ i . '> ~,The water supply projects hove brought many benefits. Purely practical improvements k X such as the provision of standpipes and the construction of pit latrines have been / R .tf . . supported by the establishment of local hierarchies to administer the schemes, and the introduction of training workshops and education programs to ensure sustainability. .~ - 4 k 3 ~Although behavioral patterns remain inconsistent between different locations, and between different socio-economic groups within each location, understanding among community members of the basic concepts of hygiene and sanitation has noticeably |' t,, / \ ' increased, and the adoption of safe hygiene practices is spreading following the fs l 11- -3 - i j project interventions. r ~ ~ ~ ~~~ , t,+ r Al. -- , .,. _ _ _ s . . , - t X - I -fi 8__' '.'' '1 ~ ~ ~ ~ ~ . ,i p' The tap attendants have also been trained to communicate health and hygiene messages- Channels of they have ample opportunities, meeting the women and children at the top stand everyday Hygiene Promotion Administration of each WaterAid- relevant community members-water commonly, through house-to-house supportedprojectishandedovertothe users and those responsible for visits. In general, VHCs are local commvnity as soon as is feasible. household hygiene - makes them supervised at community level by the Executive decision-making then lies in particularly important agents in the WATSAN Committees and are the hands of an elected Water successful dissemination of hygiene managed by VHC Coordinators Management Board (WMB). This messages. As a direct result of their attached to the WAOs. Tap attendants delegates day-to-day running of the activities, community awareness and receive a basic salary. Hygiene project.to a WaterAdministration Office understanding of such issues has education is provided free of charge. (WAO) run by salaried staff. improved considerably and positive Training for VHCs is based on the -The WAO uses a number of changes in behavior have resulted. government syllabus for community channels for hygiene promotion. VHCs conduct hygiene and health workers, and includes the Groups that play a vital role in sanitation promotion activities at tap following elements: communicating and administering stands and social gatherings and, less * Personal hygiene hygiene strategies include: * Village Hygiene Communicators Basic Health Data for Ethiopia (VHCs) Basic Heal Data for 2000i * Water and Sanitation (WATSAN) (WaterAid:AnnuolReviewAugust2000) Committees * Population 63 million * Focus Groups * Infant mortality 1 1 2 deaths per 1 000 live births * District Health Staff * Life expectancy 49 years * Access to clean water 26% of total population Village Hygiene Rural coverage 19% Communicators (VHCs) Urban coverage 91% * Access to sanitation 19% of total population Under each project, tap attendants * Rural coverage 7% and some volunteers have been . Urban coverage 97% trained as VHCs. Their proximity to 2 * Environmental sanitation * Garbage disposal WaterAid's Hygiene -and Sanitation * Safe disposal of human waste Promotion Policy * Use of safe and adequate water supplies WaterAid has developed its own 'Hygiene and Sanitation Promotion P6licy' * Prevent;on of contamination of which incorporates the following: water at source, and during * Change cannot be effective unless it is rooted in an understanding of . collection and transportation l. local culture and behovioral patterns. * Prevention of water-related ,Local grouips and individuals (VHCs and teachers, for example) can diseases . be powerful educational.agents. - * Effective communication with . * Tr6ining of local agents is:an essential precursorto progress.- - communities .Communities respond positively to participatory and inteFpersonal * Reporting approaches. . .-.- - . The success of the VHC program depends on regular refresher training, establishing and fostering links with at least four out of seven WATSAN visits, encouraging people to build focus groups, and the avoilability of Committee members are women. latrines and to clean their compounds, suitable educational materials. The ThedutiesofWATSAN Committees and supporting local VHCs. Others, time spent conducting house-to- include: however, are rather passive, and house visits is also critical. * Mobilizing communities and WaterAid has initiated measures to encouraging active participation in revive them. Water and Sanitation water issues (AWATSAN.I) Committees a Raising cash contributions Focus Groups The primary function of the WATSAN * Organizing labor for the Focus Groups consist of community Committees is to manage local water construction of watersupply facilities members who act as role models, systems afterthe formal takeoverfrom and forthe protection of vital water passing on hygiene messages to their WaterAid. Committee members are sources friends, relatives, and neighbors.. selected from within the community and * Selecting individual top ttendants/ Individuals within these groups are women play a prominent role, their VHCs . . generally well respected amongst their membership currently standing at 60 Several WATSAN committees are peers and within their communities percent. WaterAid guidelines advise that very active, conducting house-to-house, at large. ,',,,; t_N~~~w.' All three projects entailed intensive work with and among community members. WoterAid has noted progress in the quolity of communication as the projects hove been implemented consecutively Focus Groups hove no formal lack of training of government (VIPs)havebeenconstructedatschools structure and receive little orno external personnel, especially in the field of and health centers to encourage assistance, and their members work on participatory methodologies, and lack replication at other institutions. They are a voluntary basis. As a result there are of priority given to hygiene promotion made of sturdier materials than the large regionol variations in the amongst competing tasks. traditional latrine, and are designed to formotion, composition, and reduce offensive odors and decrease organizational procedures of Focus Methodologies fly populations. Groups, and they are not always effective. Nevertheless, where Focus Applied Participatory Tools and Groups are active they have proved to Practices be a valuable resource for hygiene and Several strategies have been used to Participatory methodologies aim to sanitation promotion. ensure that awareness of appropriate involve local communities in each stage hygiene and sanitation practices is oftheprocessofimprovingtheirquality District Health Staff accepted by the entire community. These of life: critical assessment of current Government health staff have been strategies include: conditions,cplanningsfor improvement, active in the promotion of hygiene and * Demonstration latrines and action. It is increasingly being sanitation for many years. District . Participatory tools and practices realized that a systematic approach health staff are generally committed . Media campaigns to this process can be a highly and well motivated due to the fact that e School visits effective tool in ensuring the success they are invariably drawn from the of projects communities they serve, and are Participatory processes, therefore, respected and appreciated by the local e Child-to-child hygiene promotion are being given high priority. Training people. workshops have been instituted, and Formal links between government Demonstration Latrines WaterAid and WaterAction are currently and project activities have been sought, Traditional Pit Latrines (TPLs) have been engaged in the, production and combiningresourcesandcoordinating built by Focus Group members as distribution of various tools and activities. District health staff have ready models for duplication by the visual aids. access to government facilities, community at large, providing an including clinics and health centers, attractive and hygienic alternative to Media Campaigns and can be called upon to conduct open-field defecation, a major source Unfortunately, the use of modern media sessions in schools and at other public of infectious disease. to convey information has had little gatherings. Collaboration is limited by Ventilated improved pit latrines success and low impact. Despite b A . ' ,'', W-.~-. . w~~~~~~~~~ i . --4_>. More costly VIP latrines hove been constructed - with i r _ . some use of non-local building moterials - for institutions Low-cost 'troditionol' latrines (with improved floors) have been promoted and and in public places, with the dual purpose of constructed by some households as an affordable option for safe excreto demonstration and sanitary improvement disposal positive feedback from those who hove seen films and attended Use of Participatory Rural Appra,isal (PRA)- campaigns, the high cost of and Other Tools audiovisual aids, and the problems associated with achieving wide The use of participatory techniques, which embrace all sections of the coverage in sprawling rural community, givinga voice'to men, women, and children alike, has proved. communities, has resulted in to bea powerfOlstimulus for ch6nge. S 'ecifictools used include:' ' low coverage. Proportionol piling exercises, which involve sorting pictures of hygiene- related situ'ations into 6ategories of different merit. This helps reveal the School Visits level of local sanitation knowledge, and provides a basis for consensus Hygiene and sanitation promotion . on sanitation issueds. through government and religious Community rhapping, whereby people are encouraged to visualiie.their schools by project staff and teachers is . situation bydr'awing pictures'of (for example) local water sources and highly effective. This is particularly so sonitation facilities. where project staff mointain close *i The 'sanitdtion ladder', a particularly effective tool utilizing simple working relations with schools, and illustrations to depict a scale of sanitation options, which community teachers have been trained and members use to discuss the relati\ve merit and feasibility of varying. provided with supporting materials. Safe - levels of improvernent. hygiene practices are tought in schools Community workshops, by which inform'ation can be fed back to local and teachers regularly check if residents. . - children are clean. Sessions focus Focus.Groupdciscussionsan-dk6y informant interviews are other. mainly on personal hygiene, avenu'es through which opinions ohd ideas canbe commuanicted cleanliness of compounds, and the - - . - -- proper use of latrines. WaterAid is introducing child-to-child learning to other family members. WaterAid Increasing Water further improve the effective transfer of plans to extend the use of child-to- Consumption Levels skills and knowledge. child learning beyond the school At present, actual per capita water House-to-House Visits environment, consumption is very low. Lack of affordability, poor access, and limited AoOtler ssues Ares'e understanding of the benefits of regular considerable allocation of VHC time to l individual households, they have FromW esteirEs personal hygiene practices in several proved to be a more effective form of Or= cm Exp *( ce communities. Measures to increase hygiene education than sessions held consumption might include wider use at tap stands and public gatherings. These pilot projects stimuloted several of differentiated tariffs, an increase in the other practical suggestions to improve number of top stonds and their hours of Child-to-Child Hygiene project effectiveness and solve operation, and more effecdivepromotion Promotion implementation problems. These of the benefits of regular bathing. Child-to-child hygiene promotion is included: employed in mony schools. The work increasing Hygiene is coordinated by school teachers Improving Access to Awareness supported by local heolth professionals, Sanitation Changes in the following pradices might and involves the use of drama, role- To increase sanitation coverage, further improve hygiene: play, and poetry. Children are innovation is required in many areas. Tap attendants are reluctant to use encouraged to think aboutthe dangers New interventions might consider: piped water to cleon tap stand of poor sanitation and contaminated Identification of very low-cost entry areas, because they must reconcile water supplies and to discuss the options cash receiptswith metered water. issues amongst themselves. Lessons Use of locolly available materials a Plastic hoses attached to taps tend learnt are then taken home and * Intensification of hygiene and to trail in the mud, contaminating disseminated at household level to sanitation promotion water drawn. Issues Related to Gender and Age An understanding of the attitudes and capabilities of different gender and age groups has proved vital to the success of these projects: ,,111 * Children who have been exposed to hygiene and sanitation messages Africa Region (WSP-AF) display high levels of understanding and awareness. upper Hill e Children have proved to be key agents of behavioral change. This is PRO. Box 30577 especially true of girls, as they take the responsibility to collect, transport, Nairobi, Kenya and store water, and assist with domestic hygiene. Young educated women tend to be more aware of hygiene issues than Telefox: r242 208 Telefax: (254-2) 260386 older illiterate women. Separate latrines for girls and boys were not available in schools. Consequently, many girls continued to defecate in the open. (Dropout rates for girls in full-time education have been linked in the past to this problem, especially at the onset of menstruation.) 0 Films and audiovisual aids were often shown in the evenings. Cultural I practices and sensibilities meant that women were unable to attend ' References these sessions. -1. WoterAid Annual Review, August 2000 2. Draft Evaluotion Report, WaterAid Ethiopia, August/September 2000 3. -Hitbsa Water Supply: A People's Projecf, o Dirty containers and unhygienic and use of participatory tools and - Trish Silkin, April 1998 stoppers and covers are commonly approaches at all levels. 4. Developing and Manoging Community used (tap attendants try to Develop tools and approaches Water Supplies, Jan Davis, Gerry Garvey, discourage this practice). immediately accessible to local 9 and Michael Wood, Oxfom 1993 0 Hand woshing after defecation is people, and not dependent on not practiced in all communities. outside materials or assistance. This Field Note was prepared -by Gary o Hygienic handling and disposal of o Employ local artists conversant with Campbell (consultant) and edited by John children,s facs.slca t Dowson. Clarissa Brocklehurst, Rose children's faeces is poor and gives local customs and imagery to Lidonde, and Tore Lium of WSP-AF reviewed cause for concern. produce visual aids and related it. It is based on projects supported by Garbage disposal in certain educational materials. - WaterAid,U.K. communities is inadequate, 0 Encourage the use of pictorial increasing the risk of insect vector- representations in all participatory related disease transmission. work in order to fully engage 0 In responding to the individual illiterate and younger members of needs of different community groups, the community. | aju hygiene and sanitation promotion o Limit the use of flip charts WaterAidprovidedthephotographs. strategies should be aware of and marker pens purchased _ religious, cultural, and gender outside the project area and Januory 2002 sensitivities. normally unavailable in the local market. The Water and Sonitotion Progrom is on Hygiene Education 0 Use materials and objects found in internationol partnership to help the Sustainability tlle immediate vicinity when I poorgaidnwte rsupplysand sonitation Sustainability of educational conducting social mapping and services. The Program's moin approaches is likely to be enhanced by similar exercises (e.g. stones, leaves, funding partners are the Governments the following measures: twigs, sand, dung, cultural and 1 of Austealia, Belgium, Canada, Denmork, o Increase the participation of women household objects). thermanetaly, wJapan, Luxembourg, and children in the dissemination Elicit responses from Switzerland,andtheUnitedKingdom; of appropriate hygiene messages. disenfranchised groups through the United Nations Development e Intensify training in the application special Focus Group discussions. Programme, and The World Bank. Created by Roots Advertising Services Pvt. Ltd. Printed by PS Pre Servises POt. Ltd. 6