Sanitation promotion: experiences from government-led initiative in southern Ethiopia

Published on: 15/04/2009

Papers from the Overseas Development Institute, in the UK, and the IRC International Water and Sanitation Centre, in the Netherlands investigate the SNNPR approach. The research was undertaken by Ethiopian researchers on behalf of the Research-inspired Policy and Practice Learning in Ethiopia and the Nile Region (RiPPLE) project.

In 2003 the SNNPR Bureau of Health (BoH) began a new community health strategy, including S&H [which aimed] to reach households through paid health extension workers (HEWs) and volunteer community health promoters (CHWs) [and which] promoted latrine construction without any form of subsidy. A combination of political promotion and institutional mobilisation was successful in launching and expanding the regional government's strategy as a ‘movement'.

The key elements of the S&H strategy were designed to be politically attractive and administratively feasible, and were written in non-technical language. The researchers found after the project:

• The proportion of households having latrines increased by a factor of eight.
• There was less acceptance of open defecation.
• Questionnaire results indicated better knowledge on hand washing, although actual practice remained poor.
• There were hand washing facilities in 82 percent of households, but only 6 percent were near the household latrine and few people used soap or detergents.
• Water storage and handling practices also remained poor.
• Men mostly decided latrine design, siting and construction, although women were involved in providing materials and plastering.

Despite these positive developments, doubts remain about sustainability and some latrines have collapsed [and] many are infested with flies. As CHWs are unpaid and receive little follow-up support or training, many have lost motivation. Higher levels of government have not provided enough technical support or monitored changes in household S&H behaviour.

Aspects of the SNNPR experience which might help improve [sanitation elsewhere] include:

• promoting local, rather than donor-driven, S&H programmes and technology designs
• using community promotional change agents coordinated by local authorities in command and facilitation roles
• reviewing local S&H progress within wider health sector review processes
• ensuring that strategising, political positioning and communication are based on solid evidence
• realising that sanitation workers cannot make their case to high-level politicians without understanding the political dynamics around S&H.

Source: id21, 01 Apr 2009