Affordable sanitation for rural India

India is one of the densest populated subcontinents in the world and has the lowest sanitation coverage. Promotion of subsidised water-sealed pour flush latrines has become a major problem for affordable sanitation, where approximately 100 million new latrines are needed to increase the coverage from the present 15 per cent to some 85 per cent or more. 24 million new latrines are estimated to be built before the year 2001. For this to happen a drastic increase in construction of latrines has to take place, requiring effective methods for commercial and social marketing and cost-effective technologies

WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial.

BACKGROUND: Researchers typically report more on the impact of public health interventions and less on the degree to which interventions were followed implementation fidelity. We developed and measured fidelity indicators for the WASH Benefits Bangladesh study, a large-scale efficacy trial, in order to identify gaps between intended and actual implementation. METHODS: Community health workers (CHWs) delivered individual and combined water, sanitation, handwashing (WSH) and child nutrition interventions to 4169 enrolled households in geographically matched clusters. Households received free enabling technologies (insulated water storage container; sani-scoop, potty, double-pit, pour-flush latrine; handwashing station, soapy-water storage bottle), and supplies (chlorine tablets, lipid-based nutrient supplements, laundry detergent sachets) integrated with parallel behavior-change promotion. Behavioral objectives were drinking treated, safely stored water, safe feces disposal, handwashing with soap at key times, and age-appropriate nutrition behaviors. We administered monthly surveys and spot-checks to households from randomly selected clusters for 6 months early in the trial. If any fidelity measures fell below set benchmarks, a rapid response mechanism was triggered. RESULTS: In the first 3 months, functional water seals were detected in 33% (14/42) of latrines in the sanitation only arm; 35% (14/40) for the combined WSH arm; and 60% (34/57) for the combined WSH and Nutrition arm, all falling below the pre-set benchmark of 80%. Other fidelity indicators met the 65 to 80% uptake benchmarks. Rapid qualitative investigations determined that households concurrently used their own latrines with broken water seals in parallel with those provided by the trial. In consultation with the households, we closed pre-existing latrines without water seals, increased the CHWs' visit frequency to encourage correct maintenance of latrines with water seals, and discouraged water-seal removal or breakage. At the sixth assessment, 86% (51/59) of households were in sanitation only; 92% (72/78) in the combined WSH; and 93% (71/76) in the combined WSH and Nutrition arms had latrines with functional water seals. CONCLUSIONS: An intensive implementation fidelity monitoring and rapid response system proved beneficial for this efficacy trial. To implement a routine program at scale requires further research into an adaptation of fidelity monitoring that supports program effectiveness. TRIAL REGISTRATION: WASH Benefits Bangladesh: ClinicalTrials.gov, ID: NCT01590095 . Registered on 30 April 2012

A study of water and sanitation in rural villages of Lamjung District, Nepal : challenges and sustainable solutions

Many people throughout the world still lack safe and affordable access to drinking water and basic sanitation. As of this year, only 83.3% and 53.1% of the population in Nepal will have ‘improved’ water resources and sanitation facilities, respectively. Improvements in water and sanitation infrastructure results in benefits to health, education and livelihoods. During March 2016, an investigation of the existing water and sanitation situation in Lamjung District was undertaken to understand the key issues facing the region. In total, 50 surveys were carried out in four different Village Development Committees (VDCs) across the district, working with the aid of four Peace Corps Volunteers (PCVs) and two Nepali interpreters. Simple Correspondence Analysis was conducted on all significant correlations to describe relationships between different variables. The results from our study were compared with findings from the 2011 National Population and Health Census, as well as other similar studies in Nepal, and this showed that Lamjung District generally has a better situation than other rural districts in Nepal with regard to access to water and sanitation. However, there were a range of issues found including insufficient quantity of water for domestic and agricultural use, poor accessibility and reliability of water sources, prevalence of waterborne diseases, a lack of protection and maintenance of water supply sources, low production of biogas, over-reliance on chemical fertilizers and inequality of access to water and sanitation between different socio-economic groups. Some of these issues were found to disproportionately affect marginalised groups such as the poor and members of lower castes, while some issues are more dependent on location and impact all groups regardless of their socio-economic status. By analysing the results and researching relevant literature, this thesis proposes sustainable solutions to all issues discovered. Concrete measures that could be implemented in Lamjung District are proposed, including implementation of sustainable low-cost technology to improve the quantity, quality, reliability and accessibility of water, and ecological sanitation systems which will have benefits both in reducing the spread of diseases and in improving crop yields through increased access to organic fertilizer made from human excreta and urine. These systems should be accompanied by better education, management and funding practices, which are also discussed.M-MIN

Assessing costs and benefits of climate change adaptation

This work was carried out by the Himalayan Adaptation, Water and Resilience (HI-AWARE) consortium under the Collaborative Adaptation Research Initiative in Africa and Asia (CARIAA) with financial support from the UK Government’s Department for International Development and the International Development Research Centre, Ottawa, Canada.This paper provides a review of existing studies of the region and an assessment of climate-related risks for different climate change scenarios. This is an essential step towards understanding what adaptation measures are required in the region, and how effective these are likely to be, including their cost effectiveness. Risk has been defined in various ways in the literature. Risks for disaster contexts typically refer to the likelihood of severe alterations in normal functioning traceable to a hazardous event, when physical hazards combine with socioeconomic vulnerabilities and lead to widespread adverse outcomes

Latrine adoption and use in rural Odisha, India: Constraints and challenges

An estimated 2.4 billion people worldwide lack access to improved sanitation. This includes nearly 1 billion people practicing open defecation, of which 60 percent reside in India. Open defecation is especially common among rural populations, and has been linked to health problems like the occurrence of diarrheal disease and malnutrition. Despite decades of efforts by the Indian government to improve sanitation, open defecation continues to be a common practice even in households possessing a functional latrine. The main aims of this research were 1) to understand the reasons for poor adoption (uptake) and use of government subsidized latrines, and 2) to identify the constraints causing latrine non adoption and use. From the constraints identified in the literature review, three constraints were selected for in-depth investigation in this dissertation :1) socio-cultural beliefs and customs around handling adult human faeces, 2) programmatic challenges in mobilising communities for latrine promotion, and 3) household level challenges with sanitation decision making, especially exploring inability of women to take decisions on sanitation installation. The study was conducted in rural areas of Odisha through a mixed methods approach. The research revealed that in this study population, latrine adoption and use by all family members is influenced by socio-cultural and behavioural rituals and restrictions on handling and containing adult human faeces close to the home. In some cases, study subjects expressed a preference for open defecation over latrine use and were able to articulate benefits and advantages. Diverse communities and lack of capacity and skill among implementers negatively impacted the implementation of sanitation campaigns. Power hierarchies, inter-generational and household dynamics prevented female family members from participating in household decisions, including latrine installation decision-making

User based perceptions of on-plot sanitation systems in low income urban communities in Africa and Asia

Rates of population growth in developing country cities are straining the capacity of sanitation service providers. In spite of widespread sector recognition of the need to adopt low-cost, people centred approaches, 80 per cent of investments in the water and sanitation sector continue to be allocated to high cost technologies for urban elites. Household level, on-plot sanitation systems potentially offer a solution to the sanitary needs of the urban poor. Nevertheless, commonly held assumptions amongst sector professionals that lower cost, on-plot systems are inappropriate and unacceptable in urban communities impede-their wider application. There is little empirical evidence to justify this position. The scope of this work examines the technical appropriateness and user acceptability of on-plot sanitation options. The thesis contributes to an improved understanding of the context in which on-plot systems operate, what factors constrain their application, and what issues need consideration when deciding on sanitary options in low-income communities. The research adopted a mix of methodological techniques to improve the reliability and validity of findings, with both quantitative and qualitative methods applied during fieldwork. Findings from Ghana, Mozambique and India are included in the thesis in order to permit sampling of key latrine types used internationally. The thesis concludes that user based perceptions of the performance and acceptability of on-plot systems varies markedly to those of sector professionals, particularly in relation to plot size, satisfaction levels and reasons for absence of household latrine. Furthermore, user based criteria of performance are developed for consideration practitioners when narrowing decision making on sanitary options. The implications of the study highlight the need for integration of user concerns into strategic planning for sanitation, more effective stimulation and negotiation of demand for sanitation systems and challenges for agencies in adopting a user oriented approach. The recommendations from the thesis include practitioner focused policy changes that affect project planning and support systems for user education. Potential areas of further research interest include ranking user perceptions, an holistic understanding of excreta management processes and institutional constraints affecting user-service provider consultations

Advantages and limitations for users of double pit pour-flush latrines: a qualitative study in rural Bangladesh

Abstract Background In rural Bangladesh, India and elsewhere, pour-flush pit latrines are the most common sanitation system. When a single pit latrine becomes full, users must empty it themselves and risk exposure to fresh feces, pay an emptying service to remove pit contents or build a new latrine. Double pit pour-flush latrines may serve as a long-term sanitation option including high water table areas because the pits do not need to be emptied immediately and the excreta decomposes into reusable soil. Methods Double pit pour-flush latrines were implemented in rural Bangladesh for ‘hardcore poor’ households by a national NGO, BRAC. We conducted interviews, focus groups, and spot checks in two low-income, rural areas of Bangladesh to explore the advantages and limitations of using double pit latrines compared to single pit latrines. Results The rural households accepted the double pit pour-flush latrine model and considered it feasible to use and maintain. This latrine design increased accessibility of a sanitation facility for these low-income residents and provided privacy, convenience and comfort, compared to open defecation. Although a double pit latrine is more costly and requires more space than a single pit latrine the households perceived this sanitation system to save resources, because households did not need to hire service workers to empty pits or remove decomposed contents themselves. In addition, the excreta decomposition process produced a reusable soil product that some households used in homestead gardening. The durability of the latrine superstructures was a problem, as most of the bamboo-pole superstructure broke after 6–18 months of use. Conclusions Double pit pour-flush latrines are a long-term improved sanitation option that offers users several important advantages over single pit pour-flush latrines like in rural Bangladesh which can also be used in areas with high water table. Further research can provide an understanding of the comparative health impacts and effectiveness of the model in preventing human excreta from entering the environment