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REPORT
Cultural and Behavioural Barriers Analysis for Positive Sanitation and
Hygiene Practice and Material Development
Prepared By
Emily Samuel
27th August 2015
2
Acknowledgement
I would like to put on record appreciation and thanks to UNICEF Eritrea Country Office and to
Dr Zemui, Director, Environmental Health, Ministry of Health, Eritrea in entrusting to me the
important task of carrying out the Cultural and Barriers analysis for Sanitation and Hygiene.
I would like to recognize the continuous support given by Ms Awet Araya, Communication for
Development Officer, Mr Martin Worth, Chief of Wash section and Mrs Yirgalem Solomon,
Wash Specialist to successfully complete this study.
I would like to especially thank and acknowledge all the efforts put by the study team Tekie
Abraha, Abraham Milash, Aman Girmai, Asmeret Teslayohannes, Martha Tesfai, Yodit Tekeste,
Bereket Mosazqhi and Habtom Solomon in carrying out the data collection process.
Emily Samuel
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Table of Content
Acknowledgement
1.Rationale and Background ...................................................................................................................... 5
2.Objectives of Study .................................................................................................................................. 6
3.Study Design ............................................................................................................................................. 6
4.Selection of Study Sites ............................................................................................................................ 7
5.Methodology and Tools ........................................................................................................................... 8
6.Literature/Documents Review ................................................................................................................ 9
7.Data Collection, Transcriptions, Summarization and Analysis ......................................................... 11
8.Limitation of the Study .......................................................................................................................... 12
9.Findings of Barriers analysis ................................................................................................................ 13
9.1 Tigrinya Ethnic Group .................................................................................................................... 14
Water Handling & Use ......................................................................................................................... 15
Latrine Coverage & Use ....................................................................................................................... 16
Handwashing and Face washing ........................................................................................................... 18
Food Hygiene ........................................................................................................................................ 19
Environment Cleanliness ...................................................................................................................... 19
The channel of communication preferred by community ..................................................................... 19
Messages to Address Barriers ............................................................................................................... 20
9.2 Tigre Ethnic Group ......................................................................................................................... 24
Background ........................................................................................................................................... 24
Water Handling and Use ....................................................................................................................... 24
Latrine Coverage and Use..................................................................................................................... 25
Environment Cleanliness ...................................................................................................................... 26
Channel of communication ................................................................................................................... 26
Messages to Address Barriers ............................................................................................................... 27
9.3 Saho Ethnic Group .......................................................................................................................... 31
Background ........................................................................................................................................... 31
Water Handling and Use ....................................................................................................................... 31
Latrine coverage and Use ..................................................................................................................... 32
Handwashing & face washing .............................................................................................................. 32
Environment Cleanliness ...................................................................................................................... 33
Messages to Address Barriers ............................................................................................................... 34
9.4 Afar Ethnic Group ........................................................................................................................... 38
Background ........................................................................................................................................... 38
Water handling and Use ........................................................................................................................ 38
4
Latrine Coverage and Use..................................................................................................................... 38
Personal Hygiene .................................................................................................................................. 39
Environment ......................................................................................................................................... 39
Messages to Address Barriers ............................................................................................................... 40
9.5 Rashaida Ethnic Group ................................................................................................................... 44
Background ........................................................................................................................................... 44
Water Handling and Use ....................................................................................................................... 44
Latrine Coverage and Use..................................................................................................................... 44
Handwashing ........................................................................................................................................ 45
Messages to Address Barriers ............................................................................................................... 46
9.6 Kunama Ethnic Group .................................................................................................................... 49
Background ........................................................................................................................................... 49
Water Handling and Use ....................................................................................................................... 49
Latrine Coverage and Use..................................................................................................................... 49
Handwashing ........................................................................................................................................ 50
Environment Cleanliness ...................................................................................................................... 50
Messages to Address Barriers ............................................................................................................... 51
9.7 Nara Ethnic Group .......................................................................................................................... 55
Background ........................................................................................................................................... 55
Water Handling and Use ....................................................................................................................... 55
Latrine coverage and use ...................................................................................................................... 55
Personal Hygiene .................................................................................................................................. 56
Environment ......................................................................................................................................... 56
Messages to Address Barriers ............................................................................................................... 57
9.8 Hidarb Ethnic Group ...................................................................................................................... 61
Background ........................................................................................................................................... 61
Water Supply and Use .......................................................................................................................... 61
Latrine Coverage and Use..................................................................................................................... 61
Personal Hygiene .................................................................................................................................. 62
Environmental Cleanliness ................................................................................................................... 62
9.9 Bilen Ethnic Group .......................................................................................................................... 63
Background ........................................................................................................................................... 63
Water Handling & Use ......................................................................................................................... 63
Personal Hygiene .................................................................................................................................. 63
10. Recommendation ................................................................................................................................. 64
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1.Rationale and Background
WASH is a central component of the millennium development agenda. The Joint Monitoring
Programme report, Progress on sanitation and drinking water: 2015 update and MDG
assessment, says worldwide, 1 in 3 people, or 2.4 billion, are still without sanitation facilities –
including 946 million people who defecate in the open. Without significant improvements in
sanitation access and hygiene practices, goals related to child mortality, primary education,
disease reduction, and poverty eradication will not be achieved1.
The Government of the State of Eritrea and UNICEF are implementing various initiatives to
improve the people’s access to water and safe sanitation facilities and to promote hygiene
practices. The Community-Led Total Sanitation (CLTS) approach in 2008 to accelerate the
sanitation coverage focused mainly on achieving sustained behaviour change through various
participatory tools and techniques to help communities realize the risks associated with open
defecation and to promote actions leading to construction and use of household latrines built by
locally available materials without any form of subsidy on the hardware component. But a lot
remains to be done to reach the MDG goal of 54% latrine coverage by 2015.
In May 2012, UNICEF commissioned a nationwide Knowledge, Attitude and Practice (KAP)
survey on Hygiene and Sanitation in six zobas- Regions. The following is the summary of the
main findings:
Regarding water handling and use, indicates in rural areas 52.8% use unimproved water
sources which includes (unprotected public well, river or stream, bottled water and other
unimproved sources).
Sanitation coverage in Eritrea is low with still 47.3% who do not have access to latrine.
Over 75 % of the rural population defecate in the open.
The critical hand washing times presented in this report were times of hand washing
before eating, after defecating and before preparing or handling food. However, study
suggests that of the existing latrines (76.7%) were observed to have no hand washing
facilities.
On food hygiene the results indicate that the community has good knowledge of making food is safe for eating by covering the food, reheating before eating, proper cooking and
immediate consumption after cooking.
Findings also revealed communities have good practice of cleaning their compound/yard.
In 2013, the results of the KAP survey results were used to inform the development of a
communication strategy for Hygiene and Sanitation (2013-2016). The communication strategy
was designed to provide a road-map for planning, implementation and monitoring of the
sanitation programme.
In response to the above, there was a felt need to conduct a formative research to identify more
specific cultural and behavioral determinants which are barriers to Sanitation and Hygiene
practice. The formative research will assist the programme through specifically providing
1 http://www.unicef.org/wash/index_bigpicture.html
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evidence based behavior change communication messages to overcoming the identified barriers
that would improve and sustain positive Sanitation and Hygiene behaviors.
2. Objectives of Study
The objectives of the barriers analysis study established in the Scope of Work are as follows:
To identify the specific behavioral determinants which are barriers to good sanitation
and hygiene;
Propose appropriate evidence based and context specific messages which will assist in
overcoming the identified barriers;
The barrier analysis will establish detailed information on determinants of five pillars of
WASH:
Household water treatment and use,
Low utilization of sanitation and hygiene services,
Personal Hygiene (Hand washing and face washing)
Food Hygiene
Environment cleanliness
Based on the findings of the study and in line with the current programme approaches, draft key
messages will be reviewed and revised. And specific messages will be developed to overcome
the cultural barriers identified by the study amongst the various ethnic groups.
3. Study Design
The research design is broadly following the formative research methodology using to generate
information from the intended groups.
The formative research used the SaniFOAM framework as a means of organizing and analyzing
the behavioral determinants as shown in the diagram below. Behavioral determinants are the
factors that can facilitate or inhibit a behavior of interest among a certain population. For
sanitation, these determinants can be internal (such as beliefs about feces) or external (such as
social norms and sanctions for open defecation). Tools and data collection approaches have been
selected and tailored accordingly to address research hypothesis developed with the health staff
and programme They are broadly explained here below;
Opportunity: Institutional or structural factors that influence an individual’s chance to perform
a behavior. Determinants within Opportunity include: access/ availability, product attributes,
social norms and sanctions/enforcement. The key question here is does the individual have the
chance to perform the behavior?
Ability: An individual’s skills and proficiency to perform a behavior. Determinants within
Ability include: knowledge, social support, skills & self efficacy, roles & decisions and
affordability. The key question here is if the individual capable of performing it?
Motivation: The drive, wishes, urges, or desires that influence an individual to perform a
behavior.
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Determinants within motivation include: attitudes and beliefs, values, emotional/physical/social
drivers, competing priorities, intention and willingness to pay. The key question here is does the
individual want to perform it?
( Source: Introducing SaniForm A Framework to analyse Sanitation Behaviors to design
Effective Sanitation Programs, Jacquline Devine, October 2009)
4. Selection of Study Sites
As a qualitative formative research, the number of villages selected is kept relatively small and
purposeful. The study sites were selected from the four Zobas (Debub, NRS, Gash Barka and
Anseba) and they were identified in consultation with MoH/UNICEF. As such, the study gave
special attention to uniqueness of ethnic groups, villages with high OD, exposure to CLTS,
rural/urban and religion and geographical variation has been taken in to consideration.
8
5. Methodology and Tools
The Formative Research on cultural and behavioural barriers analysis on Sanitation and Hygiene
in Eritrea adopted the following methodologies and tools, in a logical sequence.
Srl# Methodology Tools
1. Review of existing literatures and documents Documents , publications and reports
2. Working session with partners and core team
to define objectives, study sites, study
population and determinants and framework
for research held and inception report was
drafted and endorsed
Inception report
3. Recruitment and training of field Researchers Three day workshop, on qualitative
research methodology –FGDs, IDI
and KII
4. Focus Group Discussions with village
Men/boys and Women/ girls
FGD guide
5. In-depth Interviews Men and women In-depth guide
6. Key Informants Interviews with programme
managers, community leaders, Hygiene and
sanitation promoters, Facility based health
Semi-structured guide
S/Zone Village Ethnicity
1. Debub Mendefera Adi belay Tigrinya
Adi Keyih Hiero Saho
Dubarwa Gezalamza Tigre 2. NRS Massawa Wedibuae Raishaida
Massawa Emberemi Tigre
Foro Kadra Saho
Gelalo Gafano Afar 3. Gash Barkha Barentu Ashoshi
Kunama
Gogne Gogne
Nara
Fort Sawa Senket-Kinab
Hidarb
4 Anseba Hagaz Seberbejuk Bilen
11 9
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workers, Zonal school health focal person
7. Analysis
6. Literature/Documents Review
A number of available literatures and documents related to Sanitation and Hygiene in Africa and
Asia were reviewed. Communication strategy (2013-2016), Eritrea Country Office Strategic
Moment of Reflection 2014, Strategy Paper, Sector; WASH, KABP Study and the overall
framework designed by the technical working group, Situation Assessment Report,
Focus Group Discussion (FGD)
FGDs were conducted with homogenous groups of village men and women separately using a
FGD guide to explore issues related to the key cultural and behavioral questions centered around
the OAM determinants. Small homogeneous groups consisting of 6-12 people belonging to the
intended group were considered as a focus group. The discussions took about 1 ½ hours to 2
hours to complete each group. A total of 24 focus groups with participation from a total of 188
participants (95 Men and 93 women) were organized as shown below. With the support of
Environment health division of each Sub Zoba and the village administrator assisted in the
identification and recruitment of the intended participants.
FGDs Conducted Regions S/Zone Village Ethnicity FGDs Men FGD
Women
Total
1. Debub Mendefera Adi belay Tigrinya 1 (8) 1 (8) 16
Adi Keyih Hiero Saho 1 (6) 1 (7) 13
Dubarwa Gezalamza Tigrinya 1(8) 1 (8) 16 2. NRS
Massawa Wedibuae Raishaida 1(12) 1(8) 20
Massawa Emberemi Tigre 1(12) 1(13) 25
Foro Kadra Saho 1 (8) 1(7) 15
Gelalo Gafano Afar 1(8) 1(7) 15 3. Gash
Barka
Barentu Ashoshi
Kunama 1(6) 1(10) 16
Gogne Gogne
Nara 1(6) 1 (7) 13
Fort Sawa Senket-
Kinab
Hidarb 1 (10) 1(7) 17
Anseba
Hagaz Seberbejuk Bilen 1(11) 1(12) 23
Total 11 9 12 12 189 (Number in parentheses denotes the number of FGD discussants)
.
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In depth interviews
An in-depth interview is a qualitative research technique that allows an interviewer and the
respondent to discuss confidential and secure conversation on an issue in focus such as sanitation
behaviors or gender considerations. It can lead to increased insight into people's thoughts,
feelings, and behavior on important issues affecting them. A total of 33 in-depth interviews (18
Men and 15 Women) were conducted with various categories of village men and women who are
not involved in the FGDs. An open-ended guide will be developed for in depth interviews and
will be used to collect responses pertaining to focus cultural and behavioural barriers for
Sanitation and Hygiene in their respective community. Interviews will last 45-60 minutes. Field
researchers will make notes of the discussions.
In-depth Interviews Conducted Zoba S/Zone Village Ethnicity IDI Men IDI Women Total
1. Debub Mendefera Adi belay Tigrinya 1 - 1
Adi Keyih Hiero Saho 2 2 4
Dubarwa Gezalamza Tigre 1 - 1 2. NRS
Massawa Wedibuae Raishaida 1 1 2
Massawa Emberemi Tigre 2 1 3
Foro Kadra Saho 2 1 3
Gelalo Gafano Afar 1 2 3 3. Gash
Barka
Barentu Ashoshi Kunama 2 2 4
Gogne Gogne Nara 2 2 4
Fort Sawa Senket-
Kinab
Hidarb 2 2 4
Anseba
Hagaz Seberbejuk Bilen 2 2 4
Total 18 15 33
Key Informant Interviews
A total 14 of Key Informant Interviews were conducted in the four Zobas with various
categories of people, who were considered as key informants on the basis of their special
expertise or knowledge on the issue related to cultural and behavioural barriers pertaining to
hygiene and sanitation in their respective community (Sschool health focal persons,
Environment Health programme managers, religious leaders, community leaders, community
based health care workers, Hygiene and sanitation promoter). A semi-structured key informant
interview checklist was used to and interviews lasted 45-60 minutes. It may be noted here that
although 18 KII were planned to be conducted, only 14 KII were interviewed due to time
constraints and difficulty to get appointment with other KII.
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Key Informant Interviews Conducted Zoba S/Zone Village Ethnicity Total
1. Debub Mendefera Adi belay Tigrinya 8
Adi Keyih Hiero Saho
Dubarwa Gezalamza Tigre 2. NRS
Massawa Wedibuae Raishaida 3
Massawa Emberemi Tigre
Foro Kadra Saho
Gelalo Gafano Afar 3. Gash
Barka
Barentu Ashoshi Kunama
Barentu Gogne Nara 3
Fort Sawa Senket-
Kinab
Hidarb
Anseba
Hagaz Seberbejuk Bilen
Total 14
7. Data Collection, Transcriptions, Summarization and Analysis
Based on the research methods, tools and respondents as contained in the protocol, the data
collection for the formative research was undertaken by 8 enumerators, led by a team leader. A
three day training workshop was held in Asmara were the team leader gave an overview of
formative research, introduction on SaniFOAM, also training mainly focused on and the
development of the research questions/hypotheses, the team was also trained for one full day on
the range of “in-the-field” skills the methodologies and a detailed study of all the data collection
tools (FGD guide, KII checklist, IDI checklist) which were finalized in Asmara.
With 8 data collectors in all, data collection work took 11 days to complete. The modality of the
field operation was that the data collectors team comprising of 8 members following practical
local logistical considerations, the team first proceeded to Debub, followed by Northern Red sea
(NRS) and then finally to Gash Barka and Anseba. Translators were used when required with
certain ethnic groups.
The data processing mainly followed manual transcriptions, collation, summarization and
analysis in line with the objectives of the formative research. The team leader analysed the
findings using immersion i.e. repeated reading, to identify emerging themes, and by coding
themes arising out of the objectives and triangulation using NVivo. Quotes were extracted to
illustrate the themes.
All paper records of data, including personal identifiers and consent forms will be left with
MoH/UNICEF.
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8. Limitation of the Study
As with every assignment of this nature, there are a number of limitations. Following are some of
them:
A purposefully selected sample is not representative and study findings cannot be
generalized to the entire population.
As the payment of DSA for the data collectors was not cleared before the data collection
period began, this lead to lot of dissatisfaction amongst the data collectors, and it affected
the total number of the days of data collection.
Limited time for data collection.
o The Review workshop of IEC materials were held in all three Zoba and was
incorporated as a part of the data collection process, this reduced the number of
days allocated for data collection.
Market days in certain Zobas posed a constraint to recruit respondents for FDGs and IDIs
and it was found difficult to recruit key informant due to time constraint.
In some Zobas translators had to be used for conducting interviews, this made the
interviewing process longer.
The qualitative methodology used for this study requires lot of probing and then
expanding the field notes and having moderators with training and skills to manage group
interactions. The study were new to qualitative research methodology and lacked
experience
.
Team leader did not obtain the travel permit for Gash Barka, therefore could not
supervise the field work in this Zoba. Even though, WASH Specialist from UNICEF had
the permit to travel to Gash Barka & Anseba it was not possible to travel, due to fuel
shortage.
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9.1Tigrinya Ethnic Group
Background
The majority of the Tigrinya inhabit the highlands of Eritrea.
They are the largest ethnic group in the country, constituting
about 55% of the population2. Their language is called Tigrinya.
Most of the Tigrinya are Christians.
Their way of life evokes images of Bible times. Camels,
donkeys, and sheep are everywhere. Fields are plowed using
oxen. The Orthodox Church is a central part of the culture for the
large majority. The church buildings are constructed on hills.
Major celebrations during the year are held around the church,
where people gather from villages all around to sing, play games,
and observe the unique mass of the church, which includes a
procession through the church grounds and environs.
Coffee is a very important ceremonial drink. The "coffee ceremony" is common to the Tigrians
and the Amhara. Beans are roasted on the spot, ground and served thick and rich in tiny ceramic
cups with no handles. When the beans are roasted to smoking, they are passed around the table,
where the smoke becomes a blessing on the diners. The highlands receive most of their rainfall
during the summer months, much of which goes into tributaries of the Nile, 85% of whose water
comes from Ethiopia. The soil has been depleted by many centuries of cultivation, and water is
scarce. Using thousand year old methods, farmers plow their fields with oxen, sow seeds and
harvest by hand.
The harvest is threshed by the feet of animals. In the home, women use wood or the dried dung
of farm animals for cooking. Women often work from 12 to 16 hours daily doing domestic duties
in addition to cultivating the fields.
Each family—some with eight or more children—must provide all of its own food. Typically,
women perform all work necessary to prepare the meals from grinding the grain to roasting the
coffee beans. Children carry water in clay pots or jerry cans on their backs. Marriages are
monogamous and arranged by contract, involving a dowry given by the bride's family to the
couple.
The new couple spends some time in each family's household, before establishing their own
home at a location of their choice. Inheritance follows both family lines. Inheritance is
determined following a funeral commemoration a year after the death, which may consume most
of the deceased's estate.
The country houses are built mostly from rock, dirt, and a few timber poles. The houses blend in
easily with the natural surroundings. For many families, the nearest water source is more than a
2 World fact Book: Retrieved M
15
kilometer away from their house. In addition, they must search for fire fuel throughout the
surrounding area.
The Tigray-Tigrinya have a rich heritage of music and dance, using drums and stringed
instruments tuned to a pentatonic scale. Arts and crafts and secular music are performed by
mostly pariah artisan castes. Sacred music and iconic art is performed by monastically trained
men3
The findings presented below are from those interviewed in the Debub Zoba in the Mendefera
sub zone in the village of Adi belay.
Water Handling & Use
The community uses unsafe water source, there is only two villages from the twenty villages of
catchment area that has safe water source. As a result, this health facility stands first in the Zoba
for the ten top diseases among which is bloody diarrhoea is one of them. The main barrier behind
this is;
- Water source is same where their animals drink,
- Sewage system of the health facility is also drained through the village giving bad odor
and discomfort and bloody diarrhea. Due to this issue, the government has now made
fenced well, but this still poses other barriers like;
- Scarcity of water,
- Distance from the fenced well,
- Long que,
- Community still uses water from unprotected streams
- The majority believe that boiling water does nothing. In this community it is said that
“eta may may eya feliha Entary rishat Awtsia ilom yimigutu” which means when you boil
the water there is no dirt removed that you can see.
- Besides, there is shortage of fuel to boil water. Water treatment remains questionable.
- Community has water problems, but they still believe that water can not harm and is
considered holy”mai abesayeblun”and if it is a dug up water it is considered clean, but if
it is from streams community believes it can be contaminated.
- Women and children carry water on donkeys using Jirbas and jericans to transport it to
homes and then poured into a bigger Bermil.
- So most community members use it as it is, but there is also practice of “sheb”use which
is aluminum sulphate to treat water.
- The community is aware that contaminated water can cause diseases like schistosomiasis,
giardiasis, diarrhea, abdominal cram and vomiting.
Saying: “Clean as morning water to explain honesty of someone”. “The one who gave us water
appreciated the purity from turbidity”.
3 https://en.wikipedia.org/wiki/Tigray-Tigrinya_people#History
16
Latrine Coverage & Use
Target Group: Men and women without latrines
Behavioral Question: Why rural householders (men, women) defecate in the open?
Opportunity Ability Motivation Access/Availability
• Have no access to
latrines
• Limited access to
skilled labor
• Not affordable to
construct latrines as
stone, cement and iron
bar expensive
• Difficult to transport
no camels ,
• Rocky region
Product Attributes
• Preference is high for
stone as wood latrine
can be destroyed by
termites
• Cost for pour stone
latrine is considered
high
• Low preference for pit
latrine for its qualities
(bad smell, not user
friendly with the
old/elderly and
children, attracts
more flies
Knowledge
• Lack of knowledge
about how latrines can
prevent diseases
Social Support • No support from govt,
admin suggested to
make latrines of wood
but community
prefers brick afraid of
termites
Skills and Self-efficacy
• Community not
confident about
building simple pit
latrines due to
skills reasons
Beliefs and Attitudes
• Culturally
unacceptable &
shameful to defecate
in bare fields “chiwa
hzbi”
• Smelly, harmful don’t
it want near the house
• Belief that waste
should be kept outside
• Strong belief that
whenever someone
cleans his/her anus
with hot stone can get
hemorrhoid disease &
infection
• Belief that if some
defecates in garbage
he/she can be possess
d evil spirit
• Cultural belief by
forefathers that if you
go to latrine at noon
or mid-night you
could possessed by
evil spirit.
• Belief bride can be
possessed a pit latrine
made. After
honeymoon goes
back to OD.
17
Opportunity Ability Motivation Social/cultural norm
• Habituated with the
practice of OD difficult
to give up old traditional
habits
Sanctions/Enforcement
• No rules/policies
enforced on open
defecation in the
villages
Knowledge knowledge about the process
of how latrine use can help
prevent diseases is limited for
the men and completely
unknown for the women
Beliefs and Attitudes
• Cultural belief by
forefathers that if you
go to latrine at noon
or mid-night you
could possessed by
evil spirit.
• Belief bride can be
possessed a pit latrine
made especially for
her. After honeymoon
she goes back to
OD.
Values
• People confer low
value to latrine
construction
Summary of Findings Opportunity
Access/Availability: The practice of open defecation is due to a number of behavioral factors.
Moreover, there is a prevailing notion that it is difficult to buy the necessary sanitary products
and materials such as stone cement, iron fittings from the distant market. The non availability of
easy and reliable transportation for materials from the market to the villages is another concern.
In some villages there is shortage of stone and they bring it using camel/donkey from far places
Product Attributes: The people in general dislike the existing pit latrines for a number of
attributes. They said that it emits bad smell, is infested attracts a lot of flies. Not user friendly
with elderly and children. Preference for stone Latrines as wood is eaten by termites. However,
stone latrines are considered expensive.
Social Norms: Deeply habituated with the age old traditional practice of going to the bush that
they find quite comfortable to continue with it.
Sanctions/Enforcement: There are no formal policies or rules enforced on sanitation or open
defecation in the villages. There is an informal unwritten “fear appeal” rule of levying a fine
(monetary) to those who do not build and use a latrine for defecation.
18
Ability. While there is general awareness out diarrhoea and dysentery as the most common
water and sanitation related diseases, knowledge about the process of how latrine use can help
prevent these diseases is limited for the men and completely unknown for the women. Only a
few men could recall about how flies and fluid can be a route of disease transmission but no
recall of feces as the root route of disease transmission in any way and how latrine can break the
transmission.
Social Support: Government has asked the community to build wooden latrines but people
prefer stone latrine as they are afraid of latrine collapsing due due termites.
Skills, self-efficacy: The community as reported that they have inadequate skills to build latrines.
Motivation
Attitudes & Beliefs: There are a lot of beliefs and attitudes related to sanitation and open
defecation in particular in the community. One of the most common belief discouraging open
defecation emanates from the age-old social and cultural beliefs that by forefathers that if you go
to latrine at noon or mid-night you could possessed by evil spirit. Smelly, harmful don’t it want
near the house Belief that waste should be kept outside. Strong belief that whenever someone
cleans his/her anus with hot stone can get hemorrhoid disease & infection. Culturally
unacceptable & shameful to defecate in bare fields “chiwa hzbi”. Belief that if some defecates in
garbage he/she can be possessed evil spirit.
Value
Community Confers low value to latrine construction
Handwashing and Face washing
- In Trigniya community it is a culture that mothers take care of children concerning their
sanitation and hygiene activities.
- Some mothers clean the children’s bottom, they are unaware about consequences of
handling infant feces. Hence, they simply wash their hands merely with water. They
believe that
as far as the infant has not started eating food (he/she is on breast feed) his feces can’t
cause any diseases.
- Children wash hands of elders out of respect and in return children are blessed by their
elders, but the children do not wash their hands when they eat food with their families.
Hand washing is practiced while preparing food and when eating.
- But in ceremonial gatherings hands are not washed for instance when are about to serve
traditional drink “siwa”.
- In ceremonial gathering people wash their hands before eating. Before they are served
they wash their hands by only water and after the meal they use soap.
- It is believed that when people wash their body and go outside they can be catch cold.
This means in Tigrigna “kuri twesid”.
- .The community is aware that dirty hands can cause diseases like amoeba giardia,
abdominal cram diarrhea, amoeba, pinworm, vomiting etc.
19
Food Hygiene
Since most of this community are farmers they keep their food clean and they do not have left
over foods. There is a belief in the community that food is blessed. They believe that food causes
less or no harm to human health. To preserve the food from contamination they prepare fresh
food daily and cover their food. Leftover food are heated well. If they think that it is
contaminated it is thrown. When the leftover food is hot it is given to children. Ingera can be
stored for three days but if it kept for more than that it should be thrown away. Food is saved in
Gibabo (tradition food storage material) in the village. Left over of food is given to children
during ceremonial events as they are not allowed to attend.
Environment Cleanliness
- Some members of the community use domestic garbage is as fertilizers.
- There is no community cleaning campaign. Individuals clean their compounds by
themselves.
- It is believed if some one goes to garbage where (blood of cattle and abdominal parts of
cow have been slaughtered) he can be possessed by evil spirit.
Sayings: they insult people “garbage” so the community appreciate cleanness.
- The house hold wastes are collected in a container and it is thrown far away from the
house. These animal wastes at summer time smell and can cause malaria.
- If the animal waste at summer time is decomposed and mixed with water it creates semi
liquid solution and harbors flies which can cause diseases.
- There is a belief in by this community that a person could be possessed by evil spirit
when they sweep their home at noon time and at night. Possession by evil spirit can more
likely happen if the disposed waste (Goduf in Tigrinya) contains more ashes.
- They believe that going across the village damp places has evil spirit and they don’t
dispose their wastes during sunny day or they don’t dispose go alone to that place.
The channel of communication preferred by community
- Continuous community mobilization
- During social events messages should be disseminated by health facility experts
20
Messages to Address Barriers
MESSAGES
Identified
Barriers
Support messages to be explained Benefits Call for action messages to
address barriers
1 Water handling and use Draws water from
the unsafe water
source available
-Safe sources of safe water include piped
water and water from protected wells, wells
with hand pumps, engine-pumped wells and
protected springs.
-Unsafe water sources include water from
streams, ponds, unprotected wells, and
water delivered by trucks, donkeys or other
animal pulled carriages
Water from safe sources is clean
and has no germs that can make
you and your family healthy
Water from unsafe sources has
germs which can make you and
your family sick
-If you have to draw water from
unsafe sources, make it clean and
safe before drinking
-Boiling water does make water
Share same water
source with
animals and for
washing clothes
and utensils
Fence around the water source to keep
away animals and children
Separate areas for drawing water, watering
animals, washing clothes and utensils and
bathing
Protected water sources are clean
and have clean water
Drinking clean water from
protected wells makes you and
your family healthy and strong
Work with the village
administration to mobilize the
community to protect water
sources
Use traditional
storage and
treatment to keep
water clean
Unsafe water can cause disease Clean water makes you and your
family healthy
Water with germs will make you
and your family sick
Draw and store water in a clean,
covered container
Wash your hands before you draw
water
Use a clean container to draw
water from the storage container
21
2 Latrine coverage and use Support messages explained Benefits Call for action messages to
address barriers
People prefer to
defecate in open
fields and bushes,
Lack knowledge
about benefits of
using latrine
-When you defecate in the bush, storm
water carries your faeces into the wells and
rivers and people and children who drink
from these water sources drink some of
your faeces and get sick with diarrhea and
other diseases
-Allows you to defecate in privacy
-Keeps your compound and the
village clean and free of faeces and
smell
-Saves you the long journey to the
bush
-Saves you the shame of having to
look for a place to hide in the bush
-It ensures that your water sources
are not contaminated
-It perverts diseases such as
diarrhea and other diseases
-Defecating is natural and it is not
a shame to be seem going into a
latrine
-Train your child to defecate in a
potty or a piece of paper or cloth
-Throw the faces of your child in
the latrine
-At the age of 5-7 years train your
child to use the latrine
Afraid of wood
latrines
collapsing, prefer
stone latrines,
rocky soil,
transportation
problem to get
material
-. Seek advice and support from you Village
Health Committee or Village Administrator
on how to dig and construct your latrine
-A latrine makes your home free of
faeces, clean and free of smell
-More and more Eritreans are
building their own latrines and
saying No to open defecation.
Do not be left behind; build your
own latrine
Dig a latrine 2.5-3 meters deep.
This should last an average family
more than 10 years
A latrine can be built in any soil.
People have built latrines in the
rocky soft and sandy soils of
Eritrea
Believe that
latrine smell and
are not clean and
full of flies
-Sweep your latrine regularly, at least once
per day
Will be free of smell and flies
A clean latrine is free of smell and
flies, and is comfortable to use
Identified
barriers
Support Messages to be explained Benefits (Why) Call for action messages
address barriers
22
3 Personal hygiene and hand washing
Wash hands with
water only
Babies who has
not started eating
their feaces is
considered
harmless
Wash your hands under running water
Washing without soap does not remove all
the dirt and germs
When you wash without soap, your hands
remain with some of the dirt and germs.
And handling food with dirt in your hands
can make you and your family sick
Washing hands with water and
soap removes dirt and germs
leaving the hands clean and fresh
Clean hands help us to avoid
diseases and remain healthy
. Wash your hands with water and
soap:
-After cleaning up the baby who
has defecated, Infants and children
feces can cause disease like adults,
-Before handling or preparing food
-Before eating
-Before breastfeeding or feeding
your baby
Avoid washing hands in water that
has been used by somebody else.
It is believed
that when
people wash
their body and
go outside, they
can be catch
cold. This
means in
Tigrigna “kuri
twesid”
The more frequently you bathe, the better
for your skin and your health
Children urinate, defecate and play in dirty
places handling dirty objects and get dirtier
than adults. They need to be bathed more
frequently to remove the dirt and remain
fresh
Bathing:
Removes dirt and germs from your
skin and the skin of your baby
Opens the pores to allow the skin
to breath and become healthy and
shiny
Removes bad odor
Makes you feel relaxed and fresh
Cools your body in hot weather
Enhances your overall health
Bath with water and soap as often
as possible
-If possible daily
Bathe your child with water and
soap at least once a day
Train older children to bath with
water and soap as often as
possible, if possible daily
Use warm water if the weather is
too cold
If you cannot find enough water,
mop the parts tht sweat (such as
private parts and armpits) with
water and soap to remove bad odor
and feel fresh
4 Cleanliness of the home environment
Throw garbage in
the river or gorge
Sweep your yard and collect garbage
around the compound regularly
A clean compound:
Get a container in which to throw
garbage
23
Is tidy and attractive to look at and
sit and lie on Is safe and has no
objects that can hurt people or
children
Empty the container when it is full
and throw garbage in the garbage
hole
When the garbage hole is full bury
and make a new hole or burn to
create more space
Join other and community
members to collect garbage and
keep your school, your home and
your village clean
Defecate in the
latrine always
See under latrine coverage and use above
See above See above
24
9.2 Tigre Ethnic Group
Background
The Tigre are traditionally nomadic shepherds who occupy only
part of the north Eastern Eritrea. They are hereditary slaves, which
makes them different from other ethnic groups. The Tigre have
physical features that resemble the Egyptians and majority of them
are Muslims. They believe in an evil spirit called Zar who
possesses people and cause accidents and even death. They do not
believe in hospitals but rely on Shamans, who are the priests, for
treatment. The Shamans also control events and communicate with
the spirits4.
Water Handling and Use
The source of water for this community is from pipe and unprotected well and
unprotected stream which they consider holy surrounding St. Eiwostatios. The men and
boys fetch water. They have been using that water for decades now, though it is recently fenced the water
still not clear. So they treat the water by filtering it using a fine thread clothing and at
times most of us boil it. Some of them also use “sheb” which is Aluminum Sulphite in
order to help settle the turbid particles. Some community members also use lemon and
ashes to kill the worms.
The water has some visible microorganisms and it is hard water. At the time of hard ship
times they also drink water from streams.
Traditionally they treat their water at home by filtrating it and boil it if their children
wants to drink.
In field some of men drink water from motor well without being aware of its cleanliness;
and they believe that it cannot cause disease. This is done as a last option of to drink
instead of being thirsty. In field it was stated that at times they used to even drink their
urine, so why not to drink any water of God like “Hariet” in Tigrigna.
Lack of knowledge about water borne diseases is higher among men.
Community is aware that contaminated water can cause a disease like diarrhoea
abdominal cram jardias and kidney problems
4 : Eritrea24 Date: March 2, 2012 - Category: Culture
25
Latrine Coverage and Use
Opportunity Opportunity Motivation
Access/Availability
ODF village has latrines
Product Attributes
sandy soil, termites, and lack
of wood
Social norms Some still defecate in open
Sanctions/enforcement Internal community laws
(Sanction) which punishes
people practicing OD
Social norm Some still prefer defecate in
an open areas
Knowledge
Community understands that
open defecation can cause
disease such as diarrhoea,
abdominal cram. They get
this information from the
health workers.
Affordability Some could not build due
financial human constraints.
Have to pay 1000 Nafks to
laborer to dig a pit
Skills Community has inadequate
skills to build latrines
Beliefs/Attitudes
• Defecating during
sunny time in the
latrine and whenever
there is hot things
comes from latrine,
the person can get
haemorrhoids. To
avoid this type of
disease they pour used
motor oils ‘Olio
bershahto’ and ashes
and to avoid terrible
smell.
• Embarrassed,
ashamed when
someone see them
while defecating in
the open
• Latrine is smelly, but
outside it does not
smell since, the
weather is hot their
area it can add up
additional heat while
sitting and defecating
inside a latrine.
• Taboo to be seen
defecating by opposite
sex or family
members
• Latrines get dirty,
smells
Emotional/social drivers fear of scorpion, snakes, and
sliding to the pit
26
Handwashing
• Religion excepts this community to be clean, so hands are washed before eating
and after defecating
• It is also known that for the adults they have to wash hands five times (during pray)
with water only.
• They consider adult faeces is more harmful than the child because a child only has
milk does not eat foods.
• In this community children defecate in the compound home.
Environment Cleanliness
• They do not sweep their compound in night because they believe that the grace will
be taken away from the home also fairies will slap. Wastes collected is taken to the
other corner of the village and expected that the rainfall will take it with the flood.
• Wastes are food particles, sachets, and other dirt materials.
Channel of communication
The channel of communication preferred is through administration, community leaders, radio
and Television
27
Messages to Address Barriers
MESSAGES
Identified
Barriers
Support messages to be explained Benefits Call for action messages to
address barriers
1 Water handling and use Draws water from
the unsafe water
source available
-Safe sources of safe water include piped
water and water from protected wells, wells
with hand pumps, engine-pumped wells and
protected springs.
-Unsafe water sources include water from
streams, ponds, unprotected wells, and
water delivered by trucks, donkeys or other
animal pulled carriages
Water from safe sources is clean
and has no germs that can make
you and your family healthy
Water from unsafe sources has
germs which can make you and
your family sick
-If you have to draw water from
unsafe sources, make it clean and
safe before drinking
-Boiling water does make water
Share same water
source with
animals and for
washing clothes
and utensils
Fence around the water source to keep
away animals and children
Separate areas for drawing water, watering
animals, washing clothes and utensils and
bathing
Protected water sources are clean
and have clean water
Drinking clean water from
protected wells makes you and
your family healthy and strong
Work with the village
administration to mobilize the
community to protect water
sources
Use traditional
storage and
treatment to keep
water clean
Unsafe water can cause disease Clean water makes you and your
family healthy
Water with germs will make you
and your family sick
Draw and store water in a clean,
covered container
Wash your hands before you draw
water
Use a clean container to draw
water from the storage container
28
2 Latrine coverage and use Support messages Benefits Call for action messages to
address barriers
It is a ODF
village, however,
some still prefer
to defecate in
open fields and
bushes
-When you defecate in the bush, storm
water carries your faeces into the wells and
rivers and people and children who drink
from these water sources drink some of
your faeces and get sick with diarrhea and
other diseases
--Keeps your compound and the
village clean and free of faeces and
smell
-Saves you the long journey to the
bush
-Saves you the shame of having to
look for a place to hide in the bush
-It ensures that your water sources
are not contaminated
-It perverts diseases such as
diarrhea and other diseases
- Use your latrines, allows you to
defecate in privacy
-Train your child to defecate in a
potty or a piece of paper or cloth
-Throw the faces of your child in
the latrine
-At the age of 5-7 years train your
child to use the latrine
Afraid of sandy
soil, termites,
and latrine
collapsing
- Seek advice and support from you Village
Health Committee or Village Administrator
on how to dig and construct your latrine
-A latrine makes your home free of
feces, clean and free of smell
Dig a latrine 2.5-3 meters deep.
This should last an average family
more than 10 years
A latrine can be built in any soil.
People have built latrines in the
rocky soft and sandy soils of
Eritrea
Believe that
latrine smells, its
when its sunny
hot things comes
out giving
haemorrhoids
which gives and
are not clean and
full of flies
-Sweep your latrine regularly, at least once
per day
Will be free of smell and flies
A clean latrine is free of smell and
flies, and is comfortable to use
29
Identified
barriers
Support Messages Explained Benefits (Why) Call for action messages
address barriers
3 Personal hygiene and hand washing
Wash hands with
water only
Consider babies
who has not
started eating
their feces is
harmless
Children defecate
in the compound
Wash your hands under running water
Washing without soap does not remove all
the dirt and germs
When you wash without soap, your hands
remain with some of the dirt and germs.
And handling food with dirt in your hands
can make you and your family sick
Washing hands with water and
soap removes dirt and germs
leaving the hands clean and fresh
Clean hands help us to avoid
diseases and remain healthy
. Wash your hands with water and
soap:
-After cleaning up the baby who
has defecated, Infants and children
feces can cause disease like adults,
-Before handling or preparing food
-Before eating
-Before breastfeeding or feeding
your baby
Avoid washing hands in water that
has been used by somebody else.
Even though
religion tells
them to wash
hands
frequently the
hand washing
message should
be re enforced
The more frequently you bathe, the better
for your skin and your health
Children urinate, defecate and play in dirty
places handling dirty objects and get dirtier
than adults. They need to be bathed more
frequently to remove the dirt and remain
fresh
Bathing:
Removes dirt and germs from your
skin and the skin of your baby
Opens the pores to allow the skin
to breath and become healthy and
shiny
Removes bad odor
Makes you feel relaxed and fresh
Cools your body in hot weather
Enhances your overall health
Bath with water and soap as often
as possible
-If possible daily
Bathe your child with water and
soap at least once a day
Train older children to bath with
water and soap as often as
possible, if possible daily
Use warm water if the weather is
too cold
If you cannot find enough water,
mop the parts tht sweat (such as
private parts and armpits) with
water and soap to remove bad odor
and feel fresh
30
4 Cleanliness of the home environment
Throw garbage in
the river or gorge
Sweep your yard and collect garbage
around the compound regularly
A clean compound:
Is tidy and attractive to look at and
sit and lie on Is safe and has no
objects that can hurt people or
children
Get a container in which to throw
garbage
Empty the container when it is full
and throw garbage in the garbage
hole
When the garbage hole is full bury
and make a new hole or burn to
create more space
Join other and community
members to collect garbage and
keep your school, your home and
your village clean
Defecate in the
latrine always
See under latrine coverage and use above
See above See above
31
9.3 Saho Ethnic Group
Background
The Saho mostly reside in Foro, which is a few minutes’ drive from
Massawa, there also some Saho community living in Adi Keyih. With
good roads and organized families, this community practices farming
from where they get their food and money. A small village like Foro has
more than 200 homes with well-built houses and clean environment
because they believe in community work.
Water Handling and Use
In Adi Keyih the water source is from a fenced dug up well, this
community gets water from the river streams and even animals use this source for drinking and
people wash their clothing and their body in the streams as well.
- Water is treated by using fine threads clothing before its poured into Jericans. This
method is not used by most in the community.
- Community believes that contaminated water can cause disease like diarrhea, kidney
stone, giardia and abdominal cramp. However, children don’t have the knowledge and
drink water from anywhere.
- Community believes that diseases can be transported if the containers are not clean, they
can contaminate the water when pouring it in.
- Before they used to wash water containers with (Hamobohambo) sand and leaf. Now
containers are washed lili and water, but when one can’t find lili its washed with water
only. - The water source of the community is from closed water source they don’t belief that
their water source is safe. The water is very hard that causes diarrhea to the community
members. They relate the diarrhea to the water from their experience. Most of the
participants agree that whenever they drink water after few minutes they get diarrhea. As
a result they bring water from nearby village which is 3-5 kilometers away. Additional
source is streams particularly during rainy seasons. Water from the streams and well treat
it by settling and filtering with piece of cloth or gauze
- Aware that contaminated water can causes diseases and treat is water by boiling though it
is not cost effective and unaffordable to provide all family members by boiling.
- Religiously it is taboo (memnue from the Quran) to defecate around streams and shade of
tree. Its believed that a person can get sick if he/she defecates under a tree as it’s a a place
where people take rest.
- It is believed that everybody is obliged to keep water clean. Unless the water is not kept
clean one cannot practice religious prayers or selat. The community has a good saying
that promote good water handling that is “if you water is bad your food would be
bad”.(kolatmonoko qushitome in saho language) and they added “water is life”.
32
Latrine coverage and Use
Opportunity Opportunity Motivation
Access/Availability
• Barrier to the
community in
construction the
latrine is constructing
materials like cement
and iron bars are in
shortage.
Social Norm
• Even though some
people have latrines,
there are people who
use them and there are
people who do not use
them due history of
OD practice.
• Elderly people still
prefer OD
Sanctions/enforcement Community has a rule
financial punishment 1500
Nafka for everyone who does
not construct latrine.
Fine: 50 Nafka if seen OD,
100 Nafka second time,
Third time no social service
from administration,
If don’t stop sub
administration is informed.
Knowledge
• Good knowledge
about diseases
associated to OD like
diarrhea, vomiting,
worms, cholera,
malaria
• Community built the
latrines without being
sensitized on the
importance of not
defecating in open.
• It’s a difficult to give
sanitation & health
education to nomadic
Saho community.
Skills and Self-efficacy
• Community not
confident about
building simple pit
latrines due to skills
reasons
• Lack of skill in
constructing and
upgrading latrines
Affordability Community cannot always
afford latrines
Beliefs/Attitudes
• Embarrassed,
ashamed if seen OD
by opposite sex
• Cultural belief
whenever someone
goes to latrine during
day will get evil spirit.
• Religious leaders and
holy book dictates not
to defecate in open
it’s a taboo.
• Religion tells that
after defecating one
should wash with
water for anal
cleansing with left
hand
• Discouraged to use
latrines, due to water
shortage during dry
season march-June
• Belief that latrines are
for children and
women
• Additionally taboos
defecating under
edible trees is
forbidden
Handwashing & face washing
Religiously everybody is obliged to preform cleaning after defecation using left hand. If
they have to go the mosque they must wash hands, face and feet also when they are about
to read the Quran. And if there are in contact with blood they must wash their body.
The community practices hand, face and feet washing with soap in the morning. For
defecation separate containers are always hanging outside the latrine for washing with
soap. Women are responsible for washing the face, hands as well as body of children.
33
Children are washed hree times a day proceeding the cleaning of our selves. Hands are
washed with soap if no soap is available they wash with water only.
Women or girls having their menstrual periods (Frdi) do not wash their body or change
their cloths until the period stops. They wash their hands and face only. This practice is
based on the belief that if they wash their body, the period will not stop. Moreover, if
they change their cloths now and then, the cloths would be stained with blood. A
menstruating mother or girl also does not pray.
A father can wash his children but he would not be respected by his friends and relatives.
“It will cost him his dignity and respect in the community”.
Body is washed everyday but if there is scarcity of water every two or three days.
Environment Cleanliness
Wastes collected and put in the route of river streams, just so that it can be taken away
from the surrounding
Belief that if someone goes to garbage place at noon will be attacked be evil spirit,
especially, where the camels and cattle slaughtered. They are considered evil spirit is
from ancestors
34
Messages to Address Barriers
MESSAGES
Identified
Barriers
Support messages Explained Benefits Call for action messages to
address barriers
1 Water handling and use Draws water from
the unsafe water
source available
-Safe sources of safe water include piped
water and water from protected wells, wells
with hand pumps, engine-pumped wells and
protected springs.
-Unsafe water sources include water from
streams, ponds, unprotected wells, and
water delivered by trucks, donkeys or other
animal pulled carriages
Water from safe sources is clean
and has no germs that can make
you and your family healthy
Water from unsafe sources has
germs which can make you and
your family sick
-If you have to draw water from
unsafe sources, make it clean and
safe before drinking
-Boiling water does make water
Share same water
source with
animals and for
washing clothes
and utensils
Fence around the water source to keep
away animals and children
Separate areas for drawing water, watering
animals, washing clothes and utensils and
bathing
Protected water sources are clean
and have clean water
Drinking clean water from
protected wells makes you and
your family healthy and strong
Work with the village
administration to mobilize the
community to protect water
sources
Use traditional
storage and
treatment to keep
water clean
Unsafe water can cause disease Clean water makes you and your
family healthy
Water with germs will make you
and your family sick
Draw and store water in a clean,
covered container
Wash your hands before you draw
water
Use a clean container to draw
water from the storage container
35
2 Latrine coverage and use Support messages Benefits Call for action messages to
address barriers
It is a ODF
village, however,
some still prefer
to defecate in
open fields and
bushes
-When you defecate in the bush, storm
water carries your faeces into the wells and
rivers and people and children who drink
from these water sources drink some of
your faeces and get sick with diarrhea and
other diseases
--Keeps your compound and the
village clean and free of faeces and
smell
-Saves you the long journey to the
bush
-Saves you the shame of having to
look for a place to hide in the bush
-It ensures that your water sources
are not contaminated
-It perverts diseases such as
diarrhea and other diseases
- Use your latrines, allows you to
defecate in privacy
-Train your child to defecate in a
potty or a piece of paper or cloth
-Throw the faces of your child in
the latrine
-At the age of 5-7 years train your
child to use the latrine
Afraid of sandy
soil, termites,
and latrine
collapsing
- Seek advice and support from you Village
Health Committee or Village Administrator
on how to dig and construct your latrine
-A latrine makes your home free of
feces, clean and free of smell
Dig a latrine 2.5-3 meters deep.
This should last an average family
more than 10 years
A latrine can be built in any soil.
People have built latrines in the
rocky soft and sandy soils of
Eritrea
Believe that
latrine smells, its
when its sunny
hot things comes
out giving
haemorrhoids
which gives and
are not clean and
full of flies
-Sweep your latrine regularly, at least once
per day
Will be free of smell and flies
A clean latrine is free of smell and
flies, and is comfortable to use
36
Identified
barriers
Support Messages Explained Benefits (Why) Call for action messages
address barriers
3 Personal hygiene and hand washing
Wash hands with
water only
Consider babies
who has not
started eating
their feces is
harmless
Children defecate
in the compound
Wash your hands under running water
Washing without soap does not remove all
the dirt and germs
When you wash without soap, your hands
remain with some of the dirt and germs.
And handling food with dirt in your hands
can make you and your family sick
Washing hands with water and
soap removes dirt and germs
leaving the hands clean and fresh
Clean hands help us to avoid
diseases and remain healthy
. Wash your hands with water and
soap:
-After cleaning up the baby who
has defecated, Infants and children
feces can cause disease like adults,
-Before handling or preparing food
-Before eating
-Before breastfeeding or feeding
your baby
Avoid washing hands in water that
has been used by somebody else.
Even though
religion tells
them to wash
hands
frequently the
hand washing
message should
be re enforced
The more frequently you bathe, the better
for your skin and your health
Children urinate, defecate and play in dirty
places handling dirty objects and get dirtier
than adults. They need to be bathed more
frequently to remove the dirt and remain
fresh
Bathing:
Removes dirt and germs from your
skin and the skin of your baby
Opens the pores to allow the skin
to breath and become healthy and
shiny
Removes bad odor
Makes you feel relaxed and fresh
Cools your body in hot weather
Enhances your overall health
Bath with water and soap as often
as possible
-If possible daily
Bathe your child with water and
soap at least once a day
Train older children to bath with
water and soap as often as
possible, if possible daily
Use warm water if the weather is
too cold
If you cannot find enough water,
mop the parts tht sweat (such as
private parts and armpits) with
water and soap to remove bad odor
and feel fresh
37
4 Cleanliness of the home environment
Throw garbage in
the river or gorge
Sweep your yard and collect garbage
around the compound regularly
A clean compound:
Is tidy and attractive to look at and
sit and lie on Is safe and has no
objects that can hurt people or
children
Get a container in which to throw
garbage
Empty the container when it is full
and throw garbage in the garbage
hole
When the garbage hole is full bury
and make a new hole or burn to
create more space
Join other and community
members to collect garbage and
keep your school, your home and
your village clean
Defecate in the
latrine always
See under latrine coverage and use above
See above See above
38
9.4 Afar Ethnic Group
Background
The Afar people, who are commonly known as the Danakil, believe
that they are descendants of Noah from the Bible. They are found in
the East African countries of Somalia, Djibouti, Ethiopia and Eritrea.
Just like the Tigre, most Afar people are nomads, with milk and meat
being the major components in their diet. Their camps are
surrounded by thorn barricades to offer protection against attacks
from wild animals and enemies at large. The Afar believes in spirits
of the dead. They believe the spirits are powerful enough to solve
any problem they might have; thus they always celebrate the Raben
(Feast of the dead) yearly.
Water handling and Use
• Water source from Gelalo’s water tank, in summer if water tank is not working
well, water is fetched from surface water which is not safe to drink and increases
risk of diarrheal diseases.
• Women and children carry water to home.
• Families having many children are concerned about water contamination as their
children are always playing with water.
• This community prefers the traditional water containers to the modern plastic
containers.
• Wash water storage materials twice per week with omo, water and homemade
brushes in Tigrigna called as “meshemae” when we are fetching water
Latrine Coverage and Use
Opportunity Opportunity Motivation
Access/Availability
Latrine construction materials
like stone and cement and
iron bar expensive
Product Attributes
Latrines made of wood and
the soil is soft and collapse
frequently.
Social norm
Elderly prefer to defecate in
Knowledge Community has knowledge of
OD and diseases related to it.
Skills
community mainly lacks
human and material capacity
Affordability
Most community members
Beliefs and Attitudes
Taboo to defecate
under big tree that can
be used as shade for
humans and animals
In Afar tradition “shit
shouldn’t be kept in
one place” and they
have a perception that
it would be smelly.
latrine is used only for
brides and delivered
mothers and other
39
an open areas.
Sanctions/enforcements
Since CLTS intervention
households have constructed
the latrine to obey the village
laws.
own wood latrines as it’s
within the financial limit
vulnerable groups
scarcity of water for
latrine cleaning
shame and become
embarrassed
especially if seen by
opposite sex
Find it difficult to
defecate in the same
place.
Personal Hygiene
Traditionally in social gatherings hands are washed using water only.
When they clean children after their defecation they wash their hands using water only
Since the community has water shortage, priority is given to children to be washed.
Wash only once a week when there is shortage of water.
Environment
Afar community believes that there are evil spirit is a garbage area. If you go to the garbage area
evil spirit can possesses you and you become mentally ill.
40
Messages to Address Barriers
MESSAGES
Identified
Barriers
Support messages Explained Benefits Call for action messages to
address barriers
1 Water handling and use Draws water from
the unsafe water
source available
-Safe sources of safe water include piped
water and water from protected wells, wells
with hand pumps, engine-pumped wells and
protected springs.
-Unsafe water sources include water from
streams, ponds, unprotected wells, and
water delivered by trucks, donkeys or other
animal pulled carriages
Water from safe sources is clean
and has no germs that can make
you and your family healthy
Water from unsafe sources has
germs which can make you and
your family sick
-If you have to draw water from
unsafe sources, make it clean and
safe before drinking for your
family
-Boiling water does make water
-Don’t let children play around
unimproved water sources
Share same water
source with
animals and for
washing clothes
and utensils
Fence around the water source to keep
away animals and children
Separate areas for drawing water, watering
animals, washing clothes and utensils and
bathing
Protected water sources are clean
and have clean water
Drinking clean water from
protected wells makes you and
your family healthy and strong
Work with the village
administration to mobilize the
community to protect water
sources
Use traditional
storage and
treatment to keep
water clean
Unsafe water can cause disease Clean water makes you and your
family healthy
Water with germs will make you
and your family sick
Draw and store water in a clean,
covered container
Wash your hands before you draw
water
Use a clean container to draw
water from the storage container
2 Latrine coverage Support messages Benefits Call for action messages to
41
address barriers
It is a ODF
village, however,
some still prefer
to defecate in
open fields and
bushes. Think
latrine are for
women and
vulnerable people
-When you defecate in the bush, storm
water carries your faeces into the wells and
rivers and people and children who drink
from these water sources drink some of
your faeces and get sick with diarrhea and
other diseases
--Keeps your compound and the
village clean and free of faeces and
smell
-Saves you the long journey to the
bush
-Saves you the shame of having to
look for a place to hide in the bush
-It ensures that your water sources
are not contaminated
-It perverts diseases such as
diarrhea and other diseases
- Use your latrines, allows you to
defecate in privacy
-Train your child to defecate in a
potty or a piece of paper or cloth
-Throw the faces of your child in
the latrine
-At the age of 5-7 years train your
child to use the latrine
Afraid of sandy
soil, termites,
and latrine
collapsing
- Seek advice and support from you Village
Health Committee or Village Administrator
on how to dig and construct your latrine
-A latrine makes your home free of
feces, clean and free of smell
Dig a latrine 2.5-3 meters deep.
This should last an average family
more than 10 years
A latrine can be built in any soil.
People have built latrines in the
rocky soft and sandy soils of
Eritrea
Believe that
latrine smells, its
when its sunny
hot things comes
out giving
haemorrhoids
which gives and
are not clean and
full of flies
-Sweep your latrine regularly, at least once
per day
Will be free of smell and flies
A clean latrine is free of smell and
flies, and is comfortable to use
42
Identified
barriers
Support Messages Benefits (Why) Call for action messages
address barriers
3 Personal hygiene and hand washing
Wash hands with
water only
Consider babies
who has not
started eating
their feces is
harmless
Children defecate
in the compound
Wash your hands under running water
Washing without soap does not remove all
the dirt and germs
When you wash without soap, your hands
remain with some of the dirt and germs.
And handling food with dirt in your hands
can make you and your family sick
Washing hands with water and
soap removes dirt and germs
leaving the hands clean and fresh
Clean hands help us to avoid
diseases and remain healthy
. Wash your hands with water and
soap:
-After cleaning up the baby who
has defecated, Infants and children
feces can cause disease like adults,
-Before handling or preparing food
-Before eating
-Before breastfeeding or feeding
your baby
Avoid washing hands in water that
has been used by somebody else.
Even though
religion tells
them to wash
hands
frequently the
hand washing
message should
be re enforced
The more frequently you bathe, the better
for your skin and your health
Children urinate, defecate and play in dirty
places handling dirty objects and get dirtier
than adults. They need to be bathed more
frequently to remove the dirt and remain
fresh
Bathing:
Removes dirt and germs from your
skin and the skin of your baby
Opens the pores to allow the skin
to breath and become healthy and
shiny
Removes bad odor
Makes you feel relaxed and fresh
Cools your body in hot weather
Enhances your overall health
Bath with water and soap as often
as possible
-If possible daily
Bathe your child with water and
soap at least once a day
Train older children to bath with
water and soap as often as
possible, if possible daily
Use warm water if the weather is
too cold
If you cannot find enough water,
mop the parts tht sweat (such as
private parts and armpits) with
water and soap to remove bad odor
and feel fresh
43
4 Cleanliness of the home environment
Believe that one
can be possessed
by evil spirit and
get mentally ill
Sweep your yard and collect garbage
around the compound regularly
A clean compound:
Is tidy and attractive to look at and
sit and lie on
Is safe and has no evil spirit or
objects that can hurt people or
children
Join other and community
members to collect garbage and
keep your school, your home and
your village clean
Defecate in the
latrine always
See under latrine coverage and use above
See above See above
44
9.5 Rashaida Ethnic Group Background
The Rashaida, who originated from Saudi Arabia, have a living style
similar to the Arabians and most of them are Muslims. The dressing
code for women from a young age involves veils that cover their faces
so that men cannot see them unless the men are their own husbands.
Water Handling and Use
Source is from city municipality truck and, when there is
shortage they get from unprotected deep well (9-12m deep) from
the airport.
They also use water from a river which is not clean, which is not
protected where animals drink from this source.
Most of the time men and boys fetch water from the well using camels and also women
fetch water if they are not married.
Community is aware of the water borne diseases such as diarrhoea, vomiting and
abdominal pain skin itching if a dog salivates in the water.
Traditionally they boil water to make it safe and treat contaminated water by straining,
sedimentation, and adding salt as coagulant and boiling.
The reasons for adding salt is that community believes that salt is a medicine by itself
and can kill microorganisms that cause a disease .
Latrine Coverage and Use
Opportunity Opportunity Motivation
Social norm Tradition to defecate in an
open areas, they believe that
in their tradition “Aedat” they
do not encounter any health
related problems when they
defecate in an open fields.
Affordability
Know that flush latrines are
expensive
Beliefs and Attitudes
• nomadic lifestyle and
they don’t want to
construct temporary
latrines.
• “defecating in latrine
cuts your nose”. i.e it
smells bad
• Strongly mentioned
that they wouldn’t like
to use a toilet after
someone else had
used it as it is dirty
and smelly.
45
• Embarrassed,
ashamed to be seen
by anyone, so go to
far off bushes.
Value Prefer modern flush latrine
instead of a simple pit.
Handwashing
Take bath every Friday as it is related with their religious practice
It’s a sin and unholy to pray without being clean for this occasion
Wash their hands with water alone before eating and use soap for washing their hands
only after eating greasy foods.
Scarcity of water is one barrier main barriers for not washing their hands frequently
46
Messages to Address Barriers
MESSAGES
Identified
Barriers
Support messages Explained Benefits Call for action messages to
address barriers
1 Water handling and use Draw water from
the unsafe water
source available
-Safe sources of safe water include piped
water and water from protected wells, wells
with hand pumps, engine-pumped wells and
protected springs.
-Unsafe water sources include water from
streams, ponds, unprotected wells, and
water delivered by trucks, donkeys or other
animal pulled carriages
Water from safe sources is clean
and has no germs that can make
you and your family healthy
Water from unsafe sources has
germs which can make you and
your family sick
-If you have to draw water from
unsafe sources, make it clean and
safe before drinking for your
family
-Boiling water does make water
-Don’t let children play around
unimproved water sources
Use traditional
storage and
treatment to keep
water clean
Unsafe water can cause disease Clean water makes you and your
family healthy
Water with germs will make you
and your family sick
Draw and store water in a clean,
covered container
Wash your hands before you draw
water
Use a clean container to draw
water from the storage container
2 Latrine coverage Support messages Benefits Call for action messages to
address barriers
Nomandic
lifestyle, do not
want to construct
temporary
latrines prefer
open defecation
-When you defecate in the bush, storm
water carries your faeces into the wells and
rivers and people and children who drink
from these water sources drink some of
your faeces and get sick with diarrhea and
other diseases
--Keeps your compound and the
village clean and free of faeces and
smell
-Saves you the long journey to the
bush
Use latrine it allows you to
defecate in privacy without being
ashamed or embarrassed of being
been by others and in security
-Train your child to defecate in a
47
in the far off
bushes
-Saves you the shame of having to
look for a place to hide in the bush
-It perverts diseases such as
diarrhea and other diseases
potty or a piece of paper or cloth
-Throw the faces of your child in
the latrine
-At the age of 5-7 years train your
child to use the latrine
Believe that
latrine smells and
do not want to
use latrine used
by others
A clean latrine is free of smell and
flies, and is comfortable to use
Identified
barriers
Support Messages Benefits (Why) Call for action messages
address barriers
3 Personal hygiene and hand washing
Wash hands with
water only
Wash your hands under running water
Washing without soap does not remove all
the dirt and germs
When you wash without soap, your hands
remain with some of the dirt and germs.
And handling food with dirt in your hands
can make you and your family sick
Washing hands with water and
soap removes dirt and germs
leaving the hands clean and fresh
Clean hands help us to avoid
diseases and remain healthy
. Wash your hands with water and
soap:
-After cleaning up the baby who
has defecated, Infants and children
feces can cause disease like adults,
-Before handling or preparing food
-Before eating
-Before breastfeeding or feeding
your baby
Avoid washing hands in water that
has been used by somebody else.
Even though
religion tells
them to wash
hands
The more frequently you bathe, the better
for your skin and your health
Children urinate, defecate and play in dirty
Bathing:
Removes dirt and germs from your
skin and the skin of your baby
Bath with water and soap as often
as possible
-If possible daily
48
frequently the
hand washing
message should
be re enforced
places handling dirty objects and get dirtier
than adults. They need to be bathed more
frequently to remove the dirt and remain
fresh
Opens the pores to allow the skin
to breath and become healthy and
shiny
Removes bad odor
Makes you feel relaxed and fresh
Cools your body in hot weather
Enhances your overall health
Bathe your child with water and
soap at least once a day
Train older children to bath with
water and soap as often as
possible, if possible daily
Use warm water if the weather is
too cold
If you cannot find enough water,
mop the parts tht sweat (such as
private parts and armpits) with
water and soap to remove bad odor
and feel fresh
49
9.6 Kunama Ethnic Group
Background
The Kunama mainly reside in Gash Barka region in the border villages.
Their language has the same name as the tribe just like the other
communities except the Rashaida who speak Arabic.
Water Handling and Use
Protected and unprotected source
Drill well, open dug well and some fetch water from far rivers if
there is scarcity.
Water tanks /barrels are washed every time they see worms, larvae.
Clean contaminated water with lemon, sand, cloth and mesh. There is also practice in the
community to use small amount of kerosene in their water before they drink it
Belief in the community that water is holy and can do no harm
Latrine Coverage and Use
Opportunity Opportunity Motivation
Access/Availability
Four years back community
was given donation of vent
pipes, some cement for slab
and also a cover for the pit.
Almost everybody has latrine.
Knowledge Community has knowledge of
OD and diseases related to it.
Social support Community helps those who
are not able to build their
latrines
Beliefs and Attitudes After defecating they bury the
shit.
Burying shit was done to
avoid evil spirits attack and
not to prevent flies or
diseases.
The barrier is that in open defecation is a traditional practice. People don’t like to defecate at
home they prefer to defecate in the open while they are taking fresh air. They have the belief that
when we construct a latrine there will be flies. From experience the latrines are not properly
constructed as the science demands. Since community are constructing their latrine with local
resource and constructing a latrine is a new practice and skill to the community. As result they
don’t built the latrine as it would be. So the pit of the latrine is not deep enough, hole don’t make
as perfect faeces drops around. These shallow pit and faeces around hole attracts flies. This
practical experience influences their attitude toward latrine construction and use. From
Environmental Health (MoH) there is to shortage of skilled staff there is low follow up in proper
latrine construction.
50
On the other side since a latrine is a new skill in the community they are not forced to build
proper latrine by assuming that with time they can improve it.
Environmental health at Zoba has shortage of qualified and competent to staff to follow the
community. As a consequence to above mentioned staff shortage there is low follow up while
community building their latrines
Handwashing
Community members use indicate shortage of soap as excuse for not using soap. But this
it is related to their behaviour that makes them use water only
In ceremonies and social gathering hands are washed with water only
Due to scarcity of water body is washed twice a week
If someone washes his foot with soap, it is believed he/she will not be .able to walk long
distances.
If he washes his body with soap frequently his skin would become thinner and not
resistant
Environment Cleanliness
Community has a belief that when the trenches of cattle clean from their dang there is a fear that
number of cattle will not increase or else their animals will die. If the trench of the cattle is clean
is not good for breading their animal.
51
Messages to Address Barriers
MESSAGES
Identified
Barriers
Support messages Explained Benefits Call for action messages to
address barriers
1 Water handling and use Draws water from
the unsafe water
source available
-Safe sources of safe water include piped
water and water from protected wells, wells
with hand pumps, engine-pumped wells and
protected springs.
-Unsafe water sources include water from
streams, ponds, unprotected wells, and
water delivered by trucks, donkeys or other
animal pulled carriages
Water from safe sources is clean
and has no germs that can make
you and your family healthy
Water from unsafe sources has
germs which can make you and
your family sick
-If you have to draw water from
unsafe sources, make it clean and
safe before drinking
-Boiling water does make water
Share same water
source with
animals and for
washing clothes
and utensils
Fence around the water source to keep
away animals and children
Separate areas for drawing water, watering
animals, washing clothes and utensils and
bathing
Protected water sources are clean
and have clean water
Drinking clean water from
protected wells makes you and
your family healthy and strong
Work with the village
administration to mobilize the
community to protect water
sources
Use traditional
storage and
treatment to keep
water clean
Unsafe water can cause disease Clean water makes you and your
family healthy
Water with germs will make you
and your family sick
Draw and store water in a clean,
covered container
Wash your hands before you draw
water
Use a clean container to draw
water from the storage container
2 Latrine coverage and use Support messages Benefits Call for action messages to
52
address barriers
It is a ODF
village, however,
some still prefer
to defecate in
open fields and
bushes
-When you defecate in the bush, storm
water carries your faeces into the wells and
rivers and people and children who drink
from these water sources drink some of
your faeces and get sick with diarrhea and
other diseases
--Keeps your compound and the
village clean and free of faeces and
smell
-Saves you the long journey to the
bush
-Saves you the shame of having to
look for a place to hide in the bush
-It ensures that your water sources
are not contaminated
-It perverts diseases such as
diarrhea and other diseases
- Use your latrines, allows you to
defecate in privacy
-Train your child to defecate in a
potty or a piece of paper or cloth
-Throw the faces of your child in
the latrine
-At the age of 5-7 years train your
child to use the latrine
Afraid of sandy
soil, termites,
and latrine
collapsing
- Seek advice and support from you Village
Health Committee or Village Administrator
on how to dig and construct your latrine
-A latrine makes your home free of
feces, clean and free of smell
Dig a latrine 2.5-3 meters deep.
This should last an average family
more than 10 years
A latrine can be built in any soil.
People have built latrines in the
rocky soft and sandy soils of
Eritrea
Believe that
latrine smells, its
when its sunny
hot things comes
out giving
haemorrhoids
which gives and
are not clean and
full of flies
-Sweep your latrine regularly, at least once
per day
Will be free of smell and flies
A clean latrine is free of smell and
flies, and is comfortable to use
53
Identified
barriers
Support Messages Explained Benefits (Why) Call for action messages
address barriers
3 Personal hygiene and hand washing
Wash hands with
water only
Consider babies
who has not
started eating
their feces is
harmless
Children defecate
in the compound
Wash your hands under running water
Washing without soap does not remove all
the dirt and germs
When you wash without soap, your hands
remain with some of the dirt and germs.
And handling food with dirt in your hands
can make you and your family sick
Washing hands with water and
soap removes dirt and germs
leaving the hands clean and fresh
Clean hands help us to avoid
diseases and remain healthy
. Wash your hands with water and
soap:
-After cleaning up the baby who
has defecated, Infants and children
feces can cause disease like adults,
-Before handling or preparing food
-Before eating
-Before breastfeeding or feeding
your baby
Avoid washing hands in water that
has been used by somebody else.
Even though
religion tells
them to wash
hands
frequently the
hand washing
message should
be re enforced
The more frequently you bathe, the better
for your skin and your health
Children urinate, defecate and play in dirty
places handling dirty objects and get dirtier
than adults. They need to be bathed more
frequently to remove the dirt and remain
fresh
Bathing:
Removes dirt and germs from your
skin and the skin of your baby
Opens the pores to allow the skin
to breath and become healthy and
shiny
Removes bad odor
Makes you feel relaxed and fresh
Cools your body in hot weather
Enhances your overall health
Bath with water and soap as often
as possible
-If possible daily
Bathe your child with water and
soap at least once a day
Train older children to bath with
water and soap as often as
possible, if possible daily
Use warm water if the weather is
too cold
If you cannot find enough water,
mop the parts tht sweat (such as
private parts and armpits) with
water and soap to remove bad odor
and feel fresh
54
4 Cleanliness of the home environment
Throw garbage in
the river or gorge
Sweep your yard and collect garbage
around the compound regularly
A clean compound:
Is tidy and attractive to look at and
sit and lie on Is safe and has no
objects that can hurt people or
children
Get a container in which to throw
garbage
Empty the container when it is full
and throw garbage in the garbage
hole
When the garbage hole is full bury
and make a new hole or burn to
create more space
Join other and community
members to collect garbage and
keep your school, your home and
your village clean
Defecate in the
latrine always
See under latrine coverage and use above
See above See above
55
9.7 Nara Ethnic Group
Background
Unlike most of the other Eritrean Ethnic groups, the Nara depend on
agriculture and farming for their existence. They live in the north of
Gash River, which is in the South Western part of Eritrea. The Nara
men practice polygamy, meaning they are allowed to have as many
wives as one can afford to take care of. Each woman has a separate hut
but will live in the same compound with her co wives. The huts are
round shaped. Many of the people from this community turned to
Islam through forceful conversion. They have mosques that look like
their own huts
Water Handling and Use
Dams, streams, water truck, open dug well, mothers, boys and girls fetch water
Share water source with animals
They suffer from frequent diarrhea
They see worms in water
Consider water holy that cannot harm
Water treated by a traditional tree that has lemon taste, some filter using thread cloth,
sand
Clean water jericans with sand, pieces of plastic and OMO or liquid soap
Latrine coverage and use
Opportunity Opportunity Motivation
Access/Availability
MoH told to build latrines
Unavailability of
constructing material are
expensive
Social norm Tradition and preference to
defecate in an open areas
Knowledge Community has knowledge of
OD and diseases related to it.
Social support
Disability a barrier to
construct latrine
Affordability
Some could not build due
financial constraints
Skills
Community has inadequate
skills to build latrines
Beliefs and Attitudes
• Consider latrines
smelly and full of flies
• Ashamed to seen
going to latrine by
neighbourhood.
• Women are more
embarrassment than men
• Dignity in question
• Satan can be found in
bad smelly areas
• Latrines are
considered for women
56
Personal Hygiene
Community also fear that if they wash during their periods it may not stop or become
more so they stay for seven days without washing their body but they can wash their
hands and face.
Environment
They don’t cover the pit. They leave it there until the rain season and washed to the rivers and
streams
57
Messages to Address Barriers
MESSAGES
Identified
Barriers
Support messages Explained Benefits Call for action messages to
address barriers
1 Water handling and use Draws water from
the unsafe water
source available
-Safe sources of safe water include piped
water and water from protected wells, wells
with hand pumps, engine-pumped wells and
protected springs.
-Unsafe water sources include water from
streams, ponds, unprotected wells, and
water delivered by trucks, donkeys or other
animal pulled carriages
Water from safe sources is clean
and has no germs that can make
you and your family healthy
Water from unsafe sources has
germs which can make you and
your family sick
-If you have to draw water from
unsafe sources, make it clean and
safe before drinking
-Boiling water does make water
Share same water
source with
animals and for
washing clothes
and utensils
Fence around the water source to keep
away animals and children
Separate areas for drawing water, watering
animals, washing clothes and utensils and
bathing
Protected water sources are clean
and have clean water
Drinking clean water from
protected wells makes you and
your family healthy and strong
Work with the village
administration to mobilize the
community to protect water
sources
Use traditional
storage and
treatment to keep
water clean
Unsafe water can cause disease Clean water makes you and your
family healthy
Water with germs will make you
and your family sick
Draw and store water in a clean,
covered container
Wash your hands before you draw
water
Use a clean container to draw
water from the storage container
58
2 Latrine coverage and use Support messages Benefits Call for action messages to
address barriers
It is a ODF
village, however,
some still prefer
to defecate in
open fields and
bushes
-When you defecate in the bush, storm
water carries your faeces into the wells and
rivers and people and children who drink
from these water sources drink some of
your faeces and get sick with diarrhea and
other diseases
--Keeps your compound and the
village clean and free of faeces and
smell
-Saves you the long journey to the
bush
-Saves you the shame of having to
look for a place to hide in the bush
-It ensures that your water sources
are not contaminated
-It perverts diseases such as
diarrhea and other diseases
- Use your latrines, allows you to
defecate in privacy
-Train your child to defecate in a
potty or a piece of paper or cloth
-Throw the faces of your child in
the latrine
-At the age of 5-7 years train your
child to use the latrine
Afraid of sandy
soil, termites, and
latrine collapsing
- Seek advice and support from you Village
Health Committee or Village Administrator
on how to dig and construct your latrine
-A latrine makes your home free of
feces, clean and free of smell
Dig a latrine 2.5-3 meters deep.
This should last an average family
more than 10 years
A latrine can be built in any soil.
People have built latrines in the
rocky soft and sandy soils of
Eritrea
Believe that
latrine smells, its
when its sunny
hot things comes
out giving
haemorrhoids
which gives and
are not clean and
full of flies
-Sweep your latrine regularly, at least once
per day
Will be free of smell and flies
A clean latrine is free of smell and
flies, and is comfortable to use
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Identified
barriers
Support Messages Explained Benefits (Why) Call for action messages
address barriers
3 Personal hygiene and hand washing
Wash hands with
water only
Consider babies
who has not
started eating
their feces is
harmless
Children defecate
in the compound
Wash your hands under running water
Washing without soap does not remove all
the dirt and germs
When you wash without soap, your hands
remain with some of the dirt and germs.
And handling food with dirt in your hands
can make you and your family sick
Washing hands with water and
soap removes dirt and germs
leaving the hands clean and fresh
Clean hands help us to avoid
diseases and remain healthy
. Wash your hands with water and
soap:
-After cleaning up the baby who
has defecated, Infants and children
feces can cause disease like adults,
-Before handling or preparing food
-Before eating
-Before breastfeeding or feeding
your baby
Avoid washing hands in water that
has been used by somebody else.
Even though
religion tells
them to wash
hands
frequently the
hand washing
message should
be re enforced
The more frequently you bathe, the better
for your skin and your health
Children urinate, defecate and play in dirty
places handling dirty objects and get dirtier
than adults. They need to be bathed more
frequently to remove the dirt and remain
fresh
Bathing:
Removes dirt and germs from your
skin and the skin of your baby
Opens the pores to allow the skin
to breath and become healthy and
shiny
Removes bad odor
Makes you feel relaxed and fresh
Cools your body in hot weather
Enhances your overall health
Bath with water and soap as often
as possible
-If possible daily
Bathe your child with water and
soap at least once a day
Train older children to bath with
water and soap as often as
possible, if possible daily
Use warm water if the weather is
too cold
If you cannot find enough water,
mop the parts tht sweat (such as
private parts and armpits) with
water and soap to remove bad odor
and feel fresh
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4 Cleanliness of the home environment
Throw garbage in
the river or gorge
Sweep your yard and collect garbage
around the compound regularly
A clean compound:
Is tidy and attractive to look at and
sit and lie on Is safe and has no
objects that can hurt people or
children
Get a container in which to throw
garbage
Empty the container when it is full
and throw garbage in the garbage
hole
When the garbage hole is full bury
and make a new hole or burn to
create more space
Join other and community
members to collect garbage and
keep your school, your home and
your village clean
Defecate in the
latrine always
See under latrine coverage and use above
See above See above
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9.8 Hidarb Ethnic Group
Background
The Beja in Eritrea, or Hedareb, constitute under 5% of local residents.
They mainly live along the north-western border with Sudan. Group
members are predominately Muslim and communicate in Hedareb as a
first or second language. The Beja also include the Beni-Amer people,
who have retained their native Beja language alongside.
Water Supply and Use
Drill and tap water which is solar pumped, tap water gets broken they fetch water from
surface water known as “sheyak”. River water is also used.
While transporting water the jerricans make green substance and dust at same time.
Water is treated by using green plant, and put coal to an sometimes cloth
Tap water considered bitter.
They don’t think “sheyak” water to be contaminated
Wash jerricans with small stones to remove green matters and OMO/Lili
When water is stored at home in open lizards, reptiles contaminate water
Hard to reach community no health education has been disseminated here
Latrine Coverage and Use
Opportunity Opportunity Motivation
Access/Availability
No intervention was done
concerning the use and
construction of latrines
Social norm
Tradition and preference to
defecate in an open areas
Knowledge Community has no
knowledge of use latrines
Affordability Some could not build due
financial human constraints.
Have to pay 1000Nafks to
laborer to dig a pit
Skills Community inadequate skills
to build latrines
Beliefs and Attitudes
. Taboo to be seen
defecating by opposite
sex or family
members
• Latrines get dirty,
smells
• When sick of
diarrhoea they put
iron sheet near the
house and then throw
the sheet
• Besides is a taboo to
flatus in front of
others. If anyone does
62
that he/she is obliged
to leave the village.
• After the person
leaves the community
celebrates his
departure by making a
fist by “saying that
one who crossed the
taboo has abandoned”
• Fear if they just dig a
hole and use it they
might get sick
• family everyone uses
the same latrine the
vulnerable ones like
women and children
• can be possessed by
evil especially if they
use them at noon time
and around midnight
Personal Hygiene
Belief that if a women has her period she doesn’t take a bath because they believe that if
she washes her body her periods will disappear and she will be barren.
The women wash their hair every month when they have to be plaited
In this community if you ask for soap its considered as female behavior
Soap is presented to officials and guests only
Children are not washed frequently, belief that the child can get pneumonia
Mothers don’t wash hand after cleaning their babies bottom
The men don’t wash their body because of pneumonia also
Religiously enforced practice that husband and wife are obliged to wash their body after
having sex.
Environmental Cleanliness
Belief that if women go the waste disposal site during their menstrual time they can be possessed
by evil spirit and they will not conceive. Waste disposed into gorge.
63
9.9 Bilen Ethnic Group
Background
The Bilen in Eritrea are primarily concentrated in the north-central
areas, in and around the city of Keren, and south towards Asmara,
the nation's capital. Many of them entered Eritrea from kush
(central of Sudan) in the 8th century and settled at Merara then
they went to Lalibla and to Lasta finally they returned to Auxum
and battled with the natives, aftermath they returned to their main
base at Merara The Bilen include adherents of both Islam and
Christianity. They speak Bilen as a mother tongue. Christian
adherents are mainly urban and have intermingled with the
Tigrinya who live in the area. Muslim adherents are mainly rural
and have interbred with the adjacent Tigre.
Water Handling & Use
Scarcity of water
Water source Tap water, or big river Ashera which is not Jerricans and barrels are washed
with OMO every 2 weeks
Water is boiled and given to children
Men fetch watch water
Opportunity Opportunity Motivation
Access/Availability
Barriers are mostly obtaining
construction materials
Sanctions/enforcement
Community made regulations
and laws to punish persons
who goes against the law
Social norm
Some elders still practice OD
while having latrine old habit
Knowledge Sensitized about the
usefulness
And importance of using
latrines
Beliefs and Attitudes
Defecating in latrine
considered girlish
Difficult to sit in a
small pit to defecate
Emotional
divers/physical
Comfort
Privacy
No more shame &
embarrassment
Personal Hygiene
• Wash hands with water only not used to soaps
• Wash hair monthly before making plaits
• Belief if women washes her body during menstrual period it creates joint problems.
64
• Delivering woman doesn’t wash her body for seven days after delivering instead
uses a traditional smoke steam bath
10. Recommendation
• Multi-pronged continuous and coordinated National campaign on Sanitation and
Hygiene through:
Mass media,
Schools ( children as agents of change),
Sustainable awareness campaigns through community leaders, WASH
promotors
Booklet that being developed for sanitation promotors, community
leaders, CBOs must be disturbed across six Zobas
IPC training should be given to sanitation promoters
Regular monitoring should be done regarding the implementation of health
education and campaign programs.
Latrine Coverage and Use
• Replicate the documentation video strategy being used in Debub Zoba to scale up
ODF villages.
• With support of Sanitation Booklet, WASH promoters should be trained on IPC
skills to address the cultural, social norms, beliefs & attitudes amongst the different
ethnic groups
Handwashing
• Enhance the knowledge of the community by focusing on critical hand washing
times with soap;
– After defecation, before handling food and after cleaning children’s
bottom;
• Even though, women are closer and responsible to the house holds hygiene activity,
involving men in hygiene education and activity might improve practice of hygiene
in the community
Environment Cleanliness
• More awareness raising campaigns about cleanness of home environment are
needed.
• Having WASH promoters is the best approach in raising the awareness of the
community
• Specific dumping sites must be provided to build a clean environment.
Recommended