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CAIRO PAPERSIN SOCIAL SCIENCE

Volume 16, Monograph 2, Summer 1993

THE EMPOWERMENT OF WOMEN:WATER AND SANITATION INITIATIVES

IN RURAL EGYPT

By

SAMIHA EL KATSHASUSAN WATTS

-L ~-

:. -JE~SUP~X

P CTH~AM~RICANLthiVE~si~r1~~AIRO~RESSTe~.(070) 8i.~l1 ~ ~

~: 8~4~- 2~ -r fl%~ ‘ C — -

~D ‘Ai’~’-

Copyright (c) 1993 by the AmericanUniveisity in Cairo Press113, ShanaKasrel AimCairo, Egypt

All rights reserved. No part of this pubiLcation may be reproduced,storedin aretrieval system, or transmitted in any form or by any means,electronic,mechanical, photocopying, recoding or otherwise, without prior writtenpermissionof the copyright owner.

Dar ci Kutub No. 2233/93ISBN 977 424 311 0

Printed in Egyptat thePrintshopof the americanUniversity in Cairo

CONTENTS

ACKNOWLEDGEMENTS—---- Vi

CHAPTERONE: INTRODUCTION: WATER AND SANITATIONIN THE 1990s ————— 1

TheResearchProject— — — 1Benefitsof ImprovedWaterandSanitation — —- 2Lessonsof theUN WaterDecade- — 2The RuralEgyptianSetting——---- — — 4ResearchOrientationandMethodology- — 7Focusingon Women— ——-- 12

CHAPTERTWO: THE STUDY VILLAGES -

THE RESEARCHSETFING — — 14TheVillage Setting — 14LocalAdministrationandManagement- — 18Empowermentof Villagers - — 23

CHAPTERTHREE: INTERVENTIONS — 25Introduction:Identifying Interventions --- —- 25RepairingPublic Standpipes- — 26HandpumpInstallation — -- 33ActivitiesRelatedto thePollutedCanal — —- 36Lowering theWaterTablein Kafr Shanawan- ——--————- 42Village Committees — 45LessonsLearned— — 47

CHAPTERFOUR: WATER AND SANITATION EDUCATIONPROGRAMS --— 52

Introduction —————— 52HygieneEducationwith Village Women- — —- 55SummerClubs- — 66LessonsLearned— — 73

CHAPTERFIVE: CONCLUSION — 77TheObjectivesAccomplished- —————— 77Empowermentof Women — 77CommunityInvolved ———————————--———-- 78Local Administration — 79TheWayAhead — 80

APPENDIX I: PROCEDURESINVOLVED IN PREPARINGAFEASIBILITY STUDYTO LOWERTHE WATER LEVEL OFKAFR SHANAWAN — 82

APPENDIX II: TRAINING MAflRII’L FORHYGIENEPROMOTERS — —------- — ---- 87

APPENDIX III: GLOSSARY --- ----- ----—---—— 92

BIBUOGRAPHY - ----— -- - — 93

ABOUT THE AUTHORS --—---•-- — 99

LIST OF FIGURES

FIGURE 1: MANAGEMENT RESPONSIBILITYFOR SUPPLYFROM PIPEDWATER SOURCESANDHANDPUMPS —

2: MANAGEMENT RESPONSIBILITYFORIRRIGATION CANALS —-- —

3: MANAGEMENT RESPONSIBILITYFORHEALTHSERVICESAND TRAINING IN THE AREA OFHEALTH PROMOTION —

4: PROCEDURESINVOLVED IN REPAIRING ASTANDPIPE —

5: ALLOCATION FORAN ACTIVITY:IMPLEMENTING A SOLID WASTEDISPOSALSYSTEMIN BABIL —

6: DESIGNOFTHE HEALTH EDUCATIONPROJECTTO TESTA MODEL FORINTEGRATEDHEALTH EDUCATION — —

7: PAGEOFTHE TRAINING GUIDE

20

21

22

27

41

5457

ACKNOWLE ]X;EMENTS

Thismonographis basedon rnaleiial gatheredduring anaction researchproject in two villages in the Nile delta, The project was fundedby theInternationalDevelopmentResearchCe:tei, Ottawa,Canada,and implementedunder the auspicesof the SocialRcsearchCenter(The AmencanUniversity inCairo) from March 1986 to March 1990. Projectreportswere submittedtoIDRC for PhaseI in May 1988,foi the summerclubs in December1988, forphaseII in September1989,andfoi the rinal evaluationin February1991.

The researchteamconsistedof the Following staffof theSocial ResearchCenter, American University in Cairo: Samiha el Katsha, principalinvestigator, a social anthropologist:Awatif Younis and Esmat Kheir,sociologists;HananSabea,anthropologisi;Fikri Abdelci Wahab,operationsmanager.Dr. Kamilia MohamedSalen~from El AzharUniversity,Departmentof Public Health, wasalso part of the team. Two consultantsassistedtheteamthroughoutthe project:Dr Mofida Karnal,healtheducationand trainingspecialist,from the High Institute of Public Health, Alexandria;and Mrs.Mane Assaad,specialistin developmentand group dynamics.I)r. MohamedFadelwas the consultingsanitaryengineerfor the project. The monographwas written by SusanWatts, a geographerat the Social ResearchCenter,usmgmaterialpresentedin theprojectreports.

The team is grateful to JamesChauvin, from the InternationalDevelopmentResearchCenter.for his supportandcontinuousinterestin theproject. Thanksarealsoextendedto local governmentstaff, village formal andinformal leaders,andothervillagerswithoutwhom theprojectcould nothavebeenearnedouL

We extendour gratitudeto Dr. Gilbert White for ins encouragement,interest,andguidancethroughout the project,andespeciallyfor the supportwhichmadeit possibleto expandthe healthsummerclubsprogram.

We thank Dr. Nicholas Hopkins and Iman Hamdy for their help inpreparingthe manuscnptfor publication.

May 1993

VE

CHAPTER ONE

INTRODUCTION: WATER AND

SANITATION IN THE 1990s

The ResearchProject

In Egypt.a countrywhich haslong beenrecognizedas the gift of the Nile, theprovisionof cleanpotablewaterandadequatedrainageandsanitationfacilitiesareimportantelementsof all healthprograms.Thisresearchprojectreportedin this monographexploredwaysof improving waterandsanitationconditionsin two villages in the Nile delta. The main objectiveof the researchprojectwas to testvariousinnovativeparticipatoryapproachesto improving healthandsanitationat thevillage level. Theresearchersexploredvariouswaysofinvolving local peoplein the planningandimplementationof improvementsin water,sanitationanddrainage.and testedvariousmodelsof environmentalhealtheducation. The project soughtto empowerlocal people, especiallywomen,by encouragingtheir participationin thedecision-makingprocess,andtheir leadershipin healtheducationandcommunityactivism. Theprojectalsoidentified the governmentbodies responsiblefor the promotion of issuesrelated to health and sanitationso that proposedinterventionscould bechanneledthroughexisting administrativestructuresandvillagerscould befamiliarizedwith thestepsnecessaryto achievetheneededchanges.

Theprojectwasdesignedso it couldbereplicatedin othersettings. Thusthe researchfindings, and recommendedstrategiesto improve facilities anddevelopa healtheducationprogram,werepresentedin sucha way that theycouldbesharedwithotherconcernedlocal andnationalbodies.

The first chapter presentsan overview of water and sanitationinterventionsin general in the contextof the United Nations Health andSanitationDecade. It then turns to thespecialnatureof the problemin Egyptandthe role of rural womenin healthandsanitation. It concludeswith anexaminationof our researchorientationandmethodology.Thesecondchapterdescribesthe two studyvillages in Menoufia Governoratein the Nile DeltaThe third describesin some detail the processesinvolved in water andsanitationinterventions:the interactionbetweenthe researchteam,villagers,local formal andinformal leaders,Village Councilsandlocal administration.The fourth chapter examinesthe concurrenthygieneeducationprogramestablishedin the two studyvillages. The last chapterdrawssomegenerallessonsfrom this experience.

The researchteam in thisactionresearchprojectworkedin partnershipwith the villagers,facilitating the provisionof appropnateinterventions.Thisapproachis thus somewhatdifferent from conventionalsocial research,in

1

whichresearchersobserveand remain~tached. It is particularlyappropriatefor appliedresearch,in that it ident~fiesJieknowledge,perceptionsandneedsof local people, and harnessesIhe:e to the task of identifying andimplementingprojects,andcarryingoit effective hygieneeducation. Theprocessesandresultsof activitiescre thoroughlydocumented,andsupportingdatacollectedcarefullyandassessedrigo]rousiy,fully within the socialsciencetradition.

The action researchapproach,with its focuson facilitating communityparticipationfor change,mirrors the changingawarenessof plannersat thelocal,nationalandinternationallevel. Overthepastdecadethey haveradicallyrevisedtheir perceptionsof how effectiveinterventionsin waterandsanitationshouldbe carriedout, andrecognizedthe importanceof socialandculturalfactorsin waterandsanitationdevelopment. Hence,socialscientistsshouldnow be partnerswith plannersand engineers,as well as local people, in theimportanttask of ensuringthat water andsanitationinterventionsprovide themaximumbenefitsto local people

Benefits of Improved Water and Sanitation

Safewater and sanitationare vita! to the health of peopleeverywhere. Indevelopingcountries,abouteightyper centof all diseasefillnessis relatedinone way or anotherto water. Unprotectedwater suppliesand inadequatesanitationare relatedto many diseases~-for example.diarrhea!diseases(themajor causeof child deathin poorcountnes),schistosomiasis,guineaworm.hookworm,andeyediseasessuchastrachoma(Feachem1984).Improvingthequality, accessibilityand availability of rural water suppliesalso enhancesrural wellbeing. One immediate,widely appreciatedbenefit may be thatwomenandchildrendo nothaveto spandmany hoursa daycollecting water,andareno longerexposedto pollutedwatersources.

Lessonsof the tiN Water Decade

The United Nations InternationalDrinking Water Supply and SanitationDecade,1981-1990.highlightedthe importanceof waterandsanitationandsetthe goal of ‘wateraiid sanitationfor all’. Theinternationalrecognitiongivento the fact that in 1980 almost two thirds of the populationof developingcountrieswere withoutampleandsale watersupplies,andoverthree-quarterswithout any sanitationfacilities, put water and sanitationon the politicalagenda. The concernfor training.communityparticipation,andsmall-scaleappropriate technology,articulatedat the beginning of the decadealsorecognizedthat theprovisionof water andsanitationwasa human,ratherthanpurely technicalproblem(Bourne1984),

2

By the middle of the Decade,plannersand researchersrecognizedthatmany water and sanitationschemeshad failed due to the lack of effectiveparticipationby women,the main usersof water. Theyaskedhow women~sknowledge. roles, decision-makingand leadershipcapacitiescould beincorporatedinto water and sanitationprograms, and what were theimplicationsof women’sresponsibilityfor householdwaterandsanitationforprojectdevelopmentin the local setting(Roark 1984; Elmendorfand Isely1981).

The involvementof all membersof the community,womenandmen,inall stagesof waterandsanitationprogramswasalsorecognizedasthe key tosustainability. Plannersandresearchersstartedto seekways to involve allcommunity members,especiallywomen,at every stageof theproject (vanWsjk-Sijbesma1985). For a projectwill continueto be viable only so longas the intendedbeneficiariesrecognizeits value,helpto designtheservices,andutilize andmaintainthem.

During the WaterDecadeit also becameclear that having accesstopotablewaterdid not automaticallyimprove healthstatus,andthat therewasagreatei needto addresssanitationproblems(Bourne 1984). Thesehadbeenneglecteddunngthe Decadein spiteof thefact that many of the technicalproblemsposedby the disposalof human wastesin poor,denselysettledcommunitieshavenow been solved (Cairncross 1989). To achieve areductionin the transmissionof waterandexcretarelatedinfection, programsneedtobe carefullydesignedin orderto integratewaterquality improvements,sanitation,andhygieneeducation(Feachem1984).

Sanitationwas also definedmore broadly to include a number ofinterrelatedenvironmentalelements:sullageand solid wastedisposalandmeasuiesto improve surfaceandsubsurfacedrainageby lowering the groundwater table, as well as human excretadisposal. This broaddefinition isespeciallyrelevantin theNile valley anddelta,wheresurfacewateris abundantandgroundwaterlevels arehigh - forhere theremaybeno drainagesystemtocarryaway the watersuppliedby thepipedwatersupply,andboth surfaceandsubsurfacewater canbepollutedby ineffectivelatrinesandcasualdisposalofwastewaterandgarbage.

Thus,by the late 1980s,a shift in emphasiswas taking placeaway fromwater,per Se, towardsa moreunified approachto water,sanitationandwastemanagementtechniques.This trend,coupledwith a greaterconcernforpeople,especiallywomenwho are the actualandpotentialusersof the facilities, hasgreatlybroadenedthe concernsof plannersandresearchersseekingforwaystoprovidesalewater and sanitationforpeoplein developingcountries

The “New Delhi Statement”,issuedin 1990 at the end of the WaterDecade,pointedout that one third of the populationin the developingworldstill lackedsafewaterandsanitation,identified asthe “basicrequirementsforhealthandhumandignity” It presentedguidingprinciplesfor theprovisionof

3

safedrinking waterandenvironm,ii:alsanitationincluding: improvementinthehouseholdenvironmentthroug ‘oi ~munity involvement,partnershipandbuilding on indigenousknowledt,e p roper drainageand disposalof solidwastes;strong institutionsat the Ii K ii, regional andnational level to supportsustainability;and humandevelopiien in the form of training andeducation(UNDP 1990). Thesewere thegi icin~,insights for the actionresearchstudyof water andsanitationinitiatives iii t-’o villages in theNile delta,begun in1986.

The Rural Egyptian Setting

The populationof Egypt hasdoublediii the last thirty years,andmuchof thisgrowth hasbeenin the rural areas. Villagers havebuilt housesfor theirexpandingfamilies,often with money they earnedin theoil rich Gulf statesbetweenthe mid-1970sand the mii~-1980s.Thus,villageshaveexpandedinsize, and in housingdensity. Most v:llagesnow haveelectricityand manyhaveschools,health centers,and piped water supplies. Increasedlivingstandardsandchangingconsumptionpctlemshaveresultedin theproductionofsolid wastewhich can no longer be burned,or fed to poultry. Drainage,sullageor solid wastedisposalsystemshaverarelybeenestablishedto copewith thesechangingcircumstances.In their absence,environmentalconditionshavedeteriorated.

Water supply. Over the last forty yearswater supplieshaveimprovedin rural Egypt (see Weir et al. 1952) The majority of the larger ruralsettlementsin Egyptarenow suppliedwith pipedwater. As aresult of recentextensionsin piped water supply, the percapitaconsumptionof domesticwater in ruralEgypt hasrisendramatically,althoughthereare still problemswith quality and the irregularitycf supply (Nicholson1992;White andWhite1986).Individual householdconnectionsprovide the greatestconvenienceforwomen,and the greatesthealthbenefits,providing that suppliesare adequateandof a sufficientlyhighquality. Hov’ever, in a settlementwith a piped watersupply the proportionof householdeiswith suchconnectionsmay be quitesmall. Housesmay not haveind~v:dua1[connectionsbecauseof thehigh costof connectionsto distantpipeline:~:becauseof the unsatisfactorynatureof theservice,which detershouseholdersfrom obtainingconnections;or becauseoftheabsenceof a drainagesystem[or the wastewater. A 1992 field surveyofall of Beni Suef governorate,in Middle Egypt, indicatedthat only 18% of allresidentialbuildmgsin servedseltlem2ntsactuallyhadconnections;a smallerproportion of householdswould be seved,giventhat somebuildings housedmore thanonehousehold(Chemonics1992,p 37). Theproportionsof servedresidentialbuildings or householdsar~piobably higher in thedelta, buttheymay vary considerablyfrom placeto place. In a 1991 censusof two other

4

villages in Menoufia, the governoratein which our researchproject wasconducted,in one village almost 80% of the householdshad individualconnections;in theother the figurewas halfthat.

In settlementsprovidedwith pipedwater,manyhouseholdshaveto dependon sharedpublic standpipes. Theseare not as convenientas individualhouseholdconnectionsas womenhaveto carry waterbackto the house,theymay haveto wait for their turn, and the standpipesare more difficult tomaintain than pnvateconnections Thecensusof Egyptdefinesaccessto safedrinking water from a piped public systemas accessto either a householdconnectionor a public standpipe.Thesefiguresaresomewhatmisleading,forwe do not know how far thesestandpipesare from thehousesthey serve,orhow manypeoplethey are expectedto serve. Accordingto the 1986 census,in rural Upper Egypt (i. e. the Nile valley southof Cairo), 45% of allhouseholdswere suppliedby safednnkingwater. The figurefor theruralNiledelta was 65%: and for the governorateof Menoufia, in which this studywasconducted,was 56% (CAPMAS/UNTCEF 1989,p 31-3).

Localhandpumpsmay be usedto supplementpiped sources,or as majorsourcesin settlementsor neighborhoodswhich arenot providedwith a pipeddistribution network. However,thesehandpumpsare often shallow,as theyarehanddug andonly reachtheyear-roundsubsurfacewaterlevel; thusthey areoften polluted. Watermay also be obtainedfrom the imgationcanalsanddrains which flow throughmany Egyptianvillages. While theseare rarelyusedas regularsourcesof drinking water in villages in theNile delta,theymaybe usedoccasionallyby residentsin remotefarm hamlets,or by farmersworking in the fields. Women often use the village canalsfor washingdomesticutensilsandclothes.

Drainage and sewerage systems. The provision of sullagedisposal,drainageandseweragesystemsin Egypthasnot kept up with theexpansionof piped water supplies,andenvironmentalconditionsin manyvillages are poor (White and White 1986; Nicholson 1992). The risinggroundwatertable, and the increasingpollution of groundwater, is due to anumberof relatedfactors:the increasein waterconsumptionfor domesticuseand imgation, without properdisposalor drainagesystems:seepagefromsewagevaultsand from leakingpipes. In the absenceof a drainagesystem,pollutedstandingwateris oftenfound in low-lying openspacesin thevillages(seeGemmell 1989). Irrigationcanalsoftenbecomepollutedwith wastewaterand garbage. Thus it is not surprising that many Egyptianvillagers nowconsiderthat thedisposalof wastedomesticwater,sullage,andof sewagefromlatnnes,is a more importantproblemthan watersupply.

Solid wastedisposal.Solid wastedisposalis now an acuteproblemin many Egyptian villages,becauseof changesin consumptionpatterns,the

5

increasinguseof plastic bagsandp~ckagedgoods. Theproblemis exacerbatedby a rapidly increasingpopulation,arid heincreasein the sizeanddensityofrural settlements.In the absenceof an ~lfeclivesolid wastedisposalsystem,garbageis often thrown into the :anal;and drainswhich flow through thevillages. When thesecanalsare dredged,usually in associationwith theannualwinter canal cleaning,tins and plastic are lifted out with the mud,which thuscannotberemovedtofeiiihzc the fields,aswas the earlierpracticeThe mudandgarbagethusremainsin unsightlyheapsalongthecanalbanks.

Health. Infant andchild deathratesin Egypthavefallendramaticallyinthelast twenty years,in part due to child survival interventionssuchas highlevelsof immunizationcoverageand the increaseduse of oral rehydrationfluids, andin partduetobroadersocial andeconomicchangessuchas maternaleducationand increasedhouseholdincome. Overall infant mortality ratesinEgypt have fallen from 127 in 1947 to 70 in 1982, a decline of 45%(CAPMAS/[JNICEF 1988, p 39) More recently,a study in 12 villages inMenoufiagovernorate(the govemorateiii which the studyvillagesare situated)found that the deathrateof childrenunderfive fell by 75%between1979-80and 1990-91 (Langsten1992,p 41). However, this study found that diarrheais still themajorcauseof deathamongchildrenunderfive yearsof age;thereare twice as many deathsfrom diarrheaas from respiratoryinfections,thesecondmostimportantcauseof death(Langsten1992).

The persistenceof diarrhea,with its many water-relatedpathwaysofinfection, as a major causeof child (le;lth is eloquenttestimony of thecontinuedenvironmentalproblemscfrural Egypt. Trachoma,endemicamongchildren in rural Egypt, is also closely associatedwith poor environmentalconditions,chiefly the presenceo~’flies andlow levels of family hygiene;arecent field study in theNile delta found nearlyall childrenshowingsignsofactiveinfection(Millar andLane 1988).

Schistosomiasisis widely regardedas the one of most importantruralhealthproblemin rural Egypt,causingdebilitationat the timeof infection andseriouslong term damageincluding liver failure,kidney failure andbladdercancer. Transmissionoccursas a result o[ contaminationof canalsby unne(in the caseof Schistosomahaematobium)and feces(in the caseof S.mansoni),andexposureto infection daringwater contactactivities such aswashingdishesandclothes,swimmingandirrigation.Between15 and30% ofthe rural populationare thought to be infectedwith eitheror bothforms ofschistosomiasis(El Khoby et al. 1991).

Documentation of environmental conditions and processes.Therehavebeena numberof recentreportsof environmentalconditionsandenvironmentalhealthin Egyptianvillages, looking at thenationalsettingandmaking national-levelrecommend:thonsfor interventions(Metametncs1981;

6

Warner& Donaldson1982). Two recentconsultancyreportsstressedthe needto integratewater andsanitationinterventions,andpointedout that this wascomplicatedby thedivision of administrativeresponsibilityat all levels (K-Konsult/NOPWASD1991;USAID/ORDEV 1988).

Few in-depth field studieshaveattemptedto identify the local villagesettingswithin which theimplementationof water anddrainagesystemsmustbeconsidered(seefor exampleGemmelletal. 1991). Local level studieshavedealtbriefly with women’swaterandsanitationpracticesin relation to childhealth(Lane & Meleis 1991;Oldham 1990; Tekce1989; Hoodfar 1986). Anin-depthstudyof waterandsanitationfacilities and women’srelatedknowledgeandbehaviorin two villagesin Menoufiagovernorateforms thebasisof thepresentstudyandwaspubhshedas anearlier volumeof Cairo Papersin SocialScience(el Katshaet al. 1989,el KatshaandWhite 1989).

Involving women and community participation. In a countrysuchasEgypt. wherethe formal participationof rural womenin communitylife is limited, it is especiallyimportantto foster the participationof womenin environmentalhealthinitiatives. Theirneeds,capabilitiesandknowledgeshouldberecognized,so that theycanbea vital partof theprocessof bringingabout changeswhich they recognizewill lead to an improvementin thewellbeing andhealthof their children, their families andthecommunity as awhole.

Applied researchshouldreflect issuesrelevantto currentnationalpolicy.Self help, sustainability,self-financing and self-supportin environmentalsanitationinterventions,and the involvementof women,are currentpolicyconcernsfor the national government,pnvatevoluntaryorganizationsandbilateralandmultilateral agencies.Local communitylevel initiativesandself-help are essentialnot leastbecausethe local administrationin Egypt lacksresourcesfor maintainingandupgradingwater facilities. Currentrevenuesfrom users,as of 1990,probably coveredless than 10-15%of the operatingand maintenancecosts of piped water systems,and central governmentdisbursementsregularly fail to make up this deficit (Mayfield 1990,p 95).Thereare no environmentalhealtheducationprogramsdesignedfor theruralpopulation.

ResearchOrientation and Methodology

Background. The action/researchprojectwas undertakenin two Egyptiandelta villages betweenMarch 1986 andMarch 1990. The orientationof thisprojectwas basedon the findingsof an earlierstudyconductedbetween1984and 1986in the sametwo villages. The majorfindings of the earlier studyindicatedthat women’sbehaviorrelating to domesticwaterusewasguidedbycareful and rational decisions,influenced by the socializationprocess,and

7

adaptedto theprevailingenvironmenuil:oniiitions. Respondentsmadechoicesbasedon their own perception mid j idgements,and they had a limitedunderstandmgof thehealthhazardsrelat~idto theuseof pollutedwater. Oneofthe recommendationsof this stud’, was to inform womenof the relationshipbetweenthe use of pollutedwate- ent poor hygienestandardsanddiseasetransmission(el Katshaet al. 1989.

Action research.Action/researchprojectsseekto empowerpeopletochangetheircircumstancesand,wl-erenecessary,their behavior. Theresearchteam is a participant in, and a cataystfor, this process. In contrast,conventionalresearchattemptstobe “objective” anddetachedfrom the subjectof study; in this setting, the subjectsmust remain, as far as possible,unaffectedby the activitiesof the researchers(GrahamandJones1992). Inactionresearch,theresearchteamis aclivehyinvolved in helping local peopleto identify problems.appropriat~interventionsand/or improvements,infacilitating action,and in monitoring Lhe results. They work “with” thevillagers,not “for” th~m.CommunityparLicipalion is importantin all stagesof the interventionbeginningwith the diagnosis,and involvesdevelopingalocal perspectiveand incorporatinglocal peoplein the researchprocess(Nichter 1984).

OurEgyptianaction/researchorojectgraduallyevolvedduring thecourseof collaborationbetweenthe researchteam, formal and informal leaders,villagers,and, in our case,with ocal level administrators,clinic staff andteachers.Thus, the work plan had to lee flexible, guidedby theparticipatorynatureof the research. For exam-ole, the project beganby working withwomen,becauseof their conceni for water, sanitationand environmentalhealth. However, during the courseof the project it becameincreasinglyobviousthat men shouldalso beinvolved in activities.

A holistic, partnership approach. Health and sanitation at thevillage level has to be tackledwithin a holistic framework. New or improvedwater and sanitationfacilities cannotalone result in improved health andwellbeing. Peoplehave to learnhow to useandmaintain thesefacilities, aswell ascherishingexistinghealthfalpractices and learningnew ones(DhillonandTolsma 1992). Both health educationand changesin environmentalconditionsare neededto encourageand sustainhealthfulbehavior. Thus,adoptionof hygienicbehaviorby ‘vomenboth within andoutsidetheir homes--which is a prime objectiveof theeducationalprogramsintroducedin thisproject--wasexpectedto proceedin conjunction with activities designedtoimprovevillage sanitaryconditions

Thisaction/researchprojectalso take:;a holistic view of health,lookingat hygienebehaviorwhich may affect the transmissionof many diseases.ratherthan at interventionsdirectedata specific disease.Recentstudiesof the

C’0

mortality transitionandlong-termindicatorsof healthstatusin poorcountrieshaveindicatedthat, except~nafew extremecases,levelsof child mortalityandmorbidity havenot deterioratedin the recentyearsof economiccrisis. Thismay be because,while specific disease-basedinterventionsmay have animmediateimpacton morbidity andchild mortality, broadlybasedchangesinhealthandhygienebehavior,suchasthoserelatedtoenvironmentalhealth,canbemaintamedevenin theunfavorableeconomicclimateof the 1980s(Murray& Chen 1993)

Thepartnershipapproachinvolvesall thosewho haveaninterestin, andaresponsibilityfor, local sanitary andhealth conditions. The villagers, forwhom environmentalconditionsarea daily challengeto health,areencouragedto sharetheir local ki~owledge,expresstheir needs,andcontributewhat theycan to any interventions Local governmentstaff, doctors and clinicpersonnel,and teacherssharea responsibilityfor. improving rural health,byvirtue of their professionalrolesandknowledge. Finally, theresearchteamactsas a catalyst,and facilitatesthe activities of the otherpartiesinvolved; it

also trains villagersand local staffin activities suchas healtheducationandevaluation,andformally monitorsall activities.

A focus on community involvement ensuressustainability,as thecommunityhasanactiveinterestin the variousprograms. It alsohasanadd-on effect If the first projectundertakenby the groupis fairly straightforward,andthe local peoplerecognizeits benefits,the potential for successis greaterthan if theproject is complex Thesuccessof oneproject,which has widelyappreciatedbenefits,empowersindividualsandgroupstocontinuetheactivity,andto identify andtackleotherproblems

Establishing rapport and collaborating with villagers. Theresearchteam,who wereall Egyptianswith a longbackgroundin field work,recognizedthat patienceandcontinuoussupportfor the villagers wasessential,given that they were trying to understandpracticesand attitudesthat hadprevailedamongvillagers,especiallywomen,for years. The researcherswereawarethat only through mutual respectand trust betweenthem and thevillagerscouldcommunitydevelopmentbegin to takeroot. The researchteamwasnot free to imposeits own ideason the villagers,and hadto be flexibleenoughto give pnority to villagers suggestionsbasedon their felt needs.

Thepresenceof womenas teammemberswas crucial,especiallysincetheproject’s main target was women.Women trainerstrained local women asinterviewersandhygieneeducators.However, in this society,formal leaderswere male,andaccessto womencouldonly beobtainedthroughthemediationof malehouseholdheads.Male teammemberswere thusinvaluableworkingwith the men of the community,with the male formal and informal villageleaders,andwith local administrators.

9

The researchteam at all timesal tieredto the village styleof life withrespectto attire, manners.recipro~a1rclations,cultural normsand theuseofthe local language,colloquial Ari~bic. At times,the team memberslistenedto, andadvisedvillagerswho sougil th ~irhelpon issuesnotdirectly relatedtoproject objectives,i.e. on famil’ pla ining, income generation,and somepersonaldisputes.

Team membersexperimentedwiiii various approachesto their role asfacilitators. Theyidentified techniquesandmethodswhichcouldserveasentrypointsto the communities,andopenedchannelsof communicationbetweenvillagers,administrators,anddecision-makers.As a first stepto establishingrapportwith villagers,theresearchteamsoughtthe supportandendorsementof local authoritieson the governorate:level. At the village level, it wasnecessaryto contactthe male village leadershipfirst to familiarize themwiththeobjectivesof the projectandthe waysin which it would involve women.

Following a formal introduction 10 village level authoritiesand localnotables,weekly visits to the villages familianzedtheresearchteamwith thesocial structureand dynamicsof the community, and openedup paths ofcommunicationto the villagers,especiallythe women.Thevillagersgraduallybecameaccustomedto the presenceof theresearchteam,acceptedthem,andrecognizedthe natureof mutualconcerns. Only whenfriendly relationshadbeenestablisheddid the membersof the researchteam begin to convey toindividuals andgroupsthe objectivesof Lhe study andhow theserelated totheir everydaylife. This wasdone by usingeasily understoodlanguageandavoiding technicaltermsasmuch aspossible.

Communitymemberswere first involved in diagnosis,for they knowbetter than outsiderswhat their problemsare. This diagnosisitself is aneducationalprocess,generatingincreasedawareness(seePROWWESS/UNDP1990). The participationof women,and of men,was soughtfrom groupswithin different neighborhoodsor on an individualbasis. Womenweremadeawareof all thestepsfollowed by the researchteamandby male leadership.Partof the learningprocesswasto involve all interestedvillage womenin thediscussions,regardlessof ageor ~~tatus,andmakethemawareof the variousactivitiesundertakenby village leaders,administratorsan~researchers.

Simpleoffice quarterswererentedwithin the village, wherethe researchteammet with villagers to socialrn~arid hold meetingsand training sessions.This helpedto team to be acceptedas part of the community Cooperationwith local anddistrict level decision-neikersandpolicy makerswasessentialfor the maintenanceof local facilities and for the operationof the healtheducationprogram. Local clinic staffmid school teacherswerealsoinvolvedin thehealtheducationprogramsfm schoolchildrenandfor local women.

Research techniques--qualitative and quantitative. Becauseofits participatorynature,mostof the researchhad a qualitative,rather than

10

quantitativeorientation. Whiledistinctionsareoftenmadebetweenthe “hard”datacollectedduring quantitativesurveys,and the “soft” data collected inqualitative studies, theseapproachesneed not be mutually exclusive.Quantitativeinterview surveysprovidebasedata which can becomparedtothat collectedelsewhere,used for monitoring and to provide preliminaryguidelinesfor futurequalitativeresearch

Qualitativestudiesare neededto explorenuanceswhich would notberevealedin quantitativestudies They are processoriented, exploring thedynamics and rationale of human behavior, and provide the insider’sperspectivewhich is essentialto this research(StockIerandEng 1991). QuickstructuredsurveyssuchasKAP, to identify perceptionsandbeliefsaboutsuchtopics as water preferencesand hygienebehavior,are not likely to revealsufficiently detailed information for an action/researchproject. Carefulobservationsanddiscussionsare neededto encouragewomento identify healthproblemsandsolutions. Working with local peoplemeansbeing responsiveto local ideasandcategories,ratherthanacceptingthosealreadyidentified in astructuredquestionnaire(PROWWESS/UNDP1990: Elmendorf & Isely1981).

Researchmethodologyin this study focused on techniquessuch asparticipantobservation,unstructuredinterviews,andfocusgroupdiscussions.Forexample,focusgroupdiscussionswere conductedwith variousgroupsofhygienepromotersand among villagers to identify their perceptionsof themajor sanitaryproblems in the villages. Action researchinvolved groupmeetingswith womenin different village neighborhoods,andvillage levelcommittee meetings. Participatory techniqueswere also used in thepreliminaryandin-servicetraining andfollow-up of hygienepromoters,andintestingtraining materials.

Evaluation. The major objectiveof the study could not havebeenachievedwithout thoroughmonitoring andevaluation. The researchteammonitoredall stagesof the researchon an ongoingbasis,andcamedout adetailedfinal evaluation. They designedsimple interview surveysto testtheknowledgeof teachersand recipientsof health educationbefore and aftertraining or health educationsessions.Evaluationsof the impact of healtheducationalsocomparedthe reportedandactualbehaviorof control groups,which hadnot beenexposedto healtheducation,andexperimentalgroups,which had. Focusgroupdiscussions,formal andopen-endedinterviewswerealsousedin evaluations.

The studydoesnotattempt to documentspecific improvementsin healthwhich might have resultedfrom its activities,such as diseaseprevalence,morbidity and mortality. Suchchangesare complexto monitor andwouldrequireresourcesand a time-frame beyondthe scopeof the current study(Caimcross1989;Bnscoeet al. 1986).

11

Focusing on Women

Women’s roles. As mentionecpre~’iously.over the pastdecadetherehasbeenanincreasingrecognitionol Lie mportanceof involving womenin waterandsanitationprojects,and in at interventionsdesignedto bring aboutsocialandeconomicchangeandimprovehecithin developingsocieties.Indeedmostresearchand implementationagenciesnow specify that women shouldbegiven specialconsiderationin all developmentprojects(van Wijk-Sijbesma1985; McCormack 1985; Raikes 1989: Browner 1989). In participatoryresearchfocusingon women,the iolesof womenshouldbe identified in broadterms,so that thesecanbe exploredin the researchsettingandutilized duringthe researchproject. Although Westerncommentatorsmake an analyticaldistinction betweenwomen’sdornes~icandeconomicroles,it is salutarytorememberthat women’seconomicaclivities in the householdandthe informalsectorwere,until recently.systematicallydiscountedby beingsubsumedundertheheadingof domesticactivities(seeRogers1980).

Universally women havethe prime role in social reproduction,themaintenanceof the householdunit. They are responsiblefor the care ofchildrenandother family members;they areusuallythefirst peopleto makeajudgmentor a decisionabouta family member’sillnessor its treatment.Theirconcernfor the socializationof childrenincludesinformal educationand thetransmissionof values, attitudesand knowledge. Women, with the help oftheir older unmarriedchildren, especiallythe girls. undertakethe domesticwork of the household,suchas cooking,washingclothesand utensilsandotheractivities relatedto wateruse.

Most women engagein economicproduction This may be a directcontribution to the householdcontributedin kind from activities such asfarming andcollecting wild plantsand firewood,or cashtransactionsfromsales of produceor trading. When planning participatory research,bothdomesticandeconomicactivities (esreciallythosein the informal sector)needto berecognizedandusedaswaysof reachingwomen. Researchersalsoneedto recognizethat mostpoor women work long hours and may have littleenergy left for participationin new, unfamiliar activities with an uncertainreturn.

Within the domesticsphere.womenplay a key role in decisionsabouttheuseof technology,its acceptanceor rejection--basedon their knowledgeofwater and sanitationissuesasthey affect their families. They are usersofimprovedfacilities--if facilitiesare not used,they will not havethe desiredimpact on health andenvironmentalconditions. Women are also the mainusersof wastematerialsgeneratedin the householdeconomy;in Nile deltavillagessuchconcernsincludefeedinghouseholdwasteto chickensandgoats;making dung cakesfor fuel; andcleaningout the stable(zariba). Finally,becauseof their socializationrole within the family, women canbe both

12

targetsof environmentalhealth educationand educatorsof their familymembersand neighbors(seeElmendorf& Isely 1981; van Wijk-Sijbesma1985).

Women’s roles in social reproductionandeconomicproductiondo notnecessarilygive them leadershipanddecision-makingroles in the householdand the community. Thus, for example,in many rural communitiesit isnecessaryfor researchersand health workers to work through the maleauthority structureto gain accesstowomenandapprovalfor their cooperationin healthandenvironmentalprograms.

Encouraging women’s participation. Involvementin communityprojectsand work as peer healtheducatorspre-supposesa public role forwomen which may not be supportedby local values and the processofsocializationof women. In theMiddle Eastinparticular,andespeciallyin therural areas,the segregationof the sexesand the strict definition of rolesaccordingto genderprescribefor womena limited sphereof activities,andanoutlook that doesnot fostercommunityparticipation. A greatdealof effort isrequiredon thepart of theresearchteam to convince the women that theirpublic role is complementaryto their domestic role, and that they cantakeactionin wayswhich do not upsetcommunitymoresor their own standinginthecommunity.

Theresearchteam canencouragethis by recognizingvarious women’sparticipatoryactivities,suchas rotatingcredit groups(gamCzya), reciprocalactivities associatedwith life cycle events such as births, weddingsandfunerals,andshareddomesticactivities suchasbakingbread. Suchactivitiesare exercisedthroughnetworksof kin andneighbors,networkswhich couldbeusedby communitydevelopmentactivities. As such they representa lessobvious sourceof womens political power in the household and thecommunity. If suchactivitiesareencouragedanddiversified, theycanresultinrealempowermentandself-realization,which will extendto other activitiesandconcerns.

Womenare an activepart of the community,forming half of the adultpopulation,andtheir skills and insightsshouldnot beneglected.A balanceisneededhere, for women shouldnot be marginalizedby being treatedinisolation from the concernsof the whole community. The breadthof thisproject--incorporatingeducationfor behavioralchange--andits flexibility--beginningby focusingon women but laterincorporatingall thepeopleusingthe facilities in the planning, implementationand maintenance--fosteredaholistic viewpoint which ensureda equitableparticipationby all actualandpotentialbeneficiaries.

13

CHI PIER TWO

THE STUDt~VILLAGES - THERESEAI~CEL SETTING

The Village Setting

Introduction. The two studyvillages are situatedin Menoufiagovernorate,in the Nile delta,about 70 km ilorLi of Cairo. Babil hasa populationofapproximately5,000, andKafr Shanawan4,000. The villages havepipedwatersupplies,and the majority of housesareconnectedto the electricitysupply. Both villages have access to an Agricultural Cooperative,Community DevelopmentAssociation,veterinary servicecenter, and aconsumerscooperative; these are found in the village of Babil, and inShanawan,the village adjacentto Kafr Shanawan(literally the “hamlet ofShanawan”).Both villageshaveprimary schoolsandhealthunits. Thehealthunits providematernalandchilc healthcare, including immunization,familyplanningandthetreatmentof diarrhealdiseases(el Katshaetal. 1989,Ch2).

Environmental constraints. Environmentalconstraintsin the twovillages were identified in an earlier surveyby the researchteamin 1984/5.Bothvillages are verydenselysettledandthreadedby narrow, unpavedlanesand dead-endalleys which do not Tacilitate the introductionof a drainagesystem,or accessfor waste coJectioncarts. Open irrigation anddrainagecanalsflow through the centerof bothvillages: theseare usedfor domesticactivities,andfor thedisposalof wastedomesticwaterandsolid waste. Somewealthierfamilieshavebuilt houseson morespaciousplotson theedgeof thevillagesandalongtheapproachroads. A few families,seekingto escapefromthecongestion,havebuilt housesiii the fields (el Katshaet al. 1989,Ch. 2).

Villagershaveaccessto threewater sources;pipedwater throughhouseconnectionsor public standpipes,handpumps,andcanals.Both villageshavean abundantsupply of piped water but it is not equally accessibleto allhouseholds;few householdsin Baird haveindividual connections,whereas80%havethem in Kafr Shanawan.Public standpipes,often situatedclose tothecanalsso thatwastewatercandrainaway,are availablein bothvillages.Somehouseholds,especiallyin Babul and thosein Shanawansituatedat theedgeof thevillageaway frompipenetwork,mustrely on shallow handpumpswhich often yield pollutedwater. Canalwater is usedfor domestic tasks,butrarely for cookingor drinking,exceptby families livmg in the fields, for theyarenotconnectedto thepipedsystemandmay not haveahandpump.

At the beginningof theresearchprojectneithervillage hada sewerage,solid waste or sullage disposalsystem Most houseshad their own pit

14

latrines,but thesewere poorly maintained;they areemptiedinfrequentlyandunhygienically. Sullage,wastedomesticwater,was thrown on thestreetsorcarried to the canals(el Katshaet al. 1989, Chapter5). Becauseof thedifficulty of disposingof wastewater, it was often reused;undersuchconditionsit is likely to behighly pollutedandconstitutesa healthdangerforchildrenplaying in the streetsandwomenat the canal(Gemmellet al. 1991).In both villages the ground water level is less than one meter below thesurface:this problemhasbeenexacerbatedin recentyearsbecauseof increasingdomesticwateruse in theabsenceof a drainagesystemandthe increasinguseof waterfor imgatlon(el Katshaet al. 1989,Ch 4).

The two main typesof housingfound in the villages reflect contrastingenvironmentalconditions;mostolder housesarebuilt of mudbrick and theneweronesof fired red brick andconcrete. Sixty two percentof housesinBabil, and24% in Kafr Shanawanare of mud brick. Theseare of oneor twostones,andbuilt round a hash , courtyard,wherethe domesticactivities takeplace;theanimalshed,zariba,oftenopensonto thehash. Overall, mudbrickhouseshadless adequatewaterandsanitationfacilities thanredbrick houses,with 21%of thesamplehaving piped waterconnections,comparedto 71% ofredbrick houses,as shown in Table 1. The problemof disposingof sullageoften deterredownersof mud bnck housesfrom installingwaterconnections.Theseconnectionsare usuallysingle taps in the courtyard,adjacentto themaindoor; wateris emptiedmanuallyfrom abucketorbasin,which increasesthe problemof damp,a seriousproblemin a housewith mudbrick walls andamudfloor.

Newer houses,built of fired red brick andconcrete,often consistof aseriesof separateapartments,with individual entrancesoff a stairway,andperhapswith modemstyle kitchenandbathroomfacilities (el Katshaet al.1989,Ch 2). Theflat roofsof bothkinds of housesareoften usedfor keepingchickensandpigeons,andfor storinggrain,andthe dungcakeswhich are usedfor fuel.

The earlier study included a brief health survey. Informants mostfrequentlyreportedgastrointestinalcomplaints,followed by eye complaints,respiratorydiseases,and fevers. The predominanceof gastrointestinalcomplaints(40% in Babil and35% in Kafr Shanawan),andeyecomplaints32% and 31% respectively,suggestthe importanceof faecal-oraldiseasetransmissionroutes,relatedto the quantityandquality of water availableandthepooroverall environmentalconditionsin thevillage (el Katshaet al. 1989pp. 6-7).

15

1’ALLE 1FACILITIES IN MIJID BRICK AND RED

BRICK HOUSES

Characteristics MudBrick RedBrickn=117 n~175

Householdwaterconnection 21% 71%Latrine 86% 95%Mud floor 85% 55%Separatekitchen 13% 60%Animal shed 88% 27%Electricity 98% 99%

Source:el Katshaet al. 1989,p. 18.

Women’swater and sanitationpractices. In Egypt, as elsewhere,womenplay key rolesin wateruseandmanagement.Patternsof wateruse inbothvillages,whetherthesourcesusedarehouseholdtaps,public standpipes,handpumpsor canals,reflect the socializationprocess,andwomen’scarefulassessmentof the relative advantagesof various sources. For example,village women gavemany reasonswhy they used the canal for washingclothesandhouseholdutensilsevenif they hada waterconnectionin or neartheir house. They perceivedthat flowing canal water was “clean”; theypreferredit to thehighly mineralizedLap water becauseit got clothesandaluminumutensilssparklingclean,and the flowing water gaveeverythingagoodrinse. Evenwhenwomenhad householdwaterconnections,washinginthe housewas no more convenienttitian washingat thecanal. Womenareaccustomedto squattingwhiledoing manydomestictasks,andthey washedinbasinson the floor, ratherthan standingat a sink. Thispracticealsousedlesswater--whichhad to be carriedoutol the house. Our generalfindings echothoseof otherstudies,in so far asthey suggestthat: “women in their choicesof water sources,makereasonabledecisionsbasedon their own criteria ofaccess,time, effort, water quality, quantity and reliability” (van Wijk-Sijbesma,1985,quotedin El Katshaet al. 1989,p 70). Clearly, in the studyvillages,as elsewhere,any attemptto changewater usebehaviormuststartfrom anunderstandingthe women’sown rationalefor theirbehavior.

The earlier researchalso identified a numberof unhealthfulhygienepracticesby women. The settingfor women’sdaily activities,especiallyintheoldermud-brickhousesin the mostcongestedareaof thevillage, doesnotencouragehygienicpractices. Animal shedsare often locatedwithin thecourtyard,andpoultry roam throughoutthe house. Cooking usually takesplaceon thefloor in closeproximity to animals.

16

Most rural womenare notsocializedto washtheir handsbeforeandaftercertain tasks; they do not habitually wash their handsbefore handling orprepanngfood, or beforefeedinginfants. Neitherdo womenregularly washtheirhandswith soaporchangetheir clothesaftermakingdung cakesby hand.Women gavea low pnontyto cleaningthe latrine. In mostcases,they didnot storewater hygienically. Outsidethe house,in the absenceof any solidwasteor sullagecollectionsystem,canalsandstreetsare usedfor solid wasteand sullage disposal (el Katshaet al. 1989, Ch. 5, 6). Environmentalconditionsdo notmakeit easyfor womento behavein healthfulways.

Womenin the studyvillages work long hours at variousdomesticandeconomictasks;theseactivities may leavethem little time for participatoryactivities even in areas,such as water and sanitation,in which they havespecialknowledgeandexpertise. Theburdenof daily activities is especiallyheavyfor a young woman,who may bepregnant,or be expectedto help hermother-in-law. One womenexpressedher feelingabouther daily activitiesthus: “By nightfall I feel as if somebodyis bangingmy head,as a result ofcarryingwaterbackandforth during theday. I haveno energyto do anythingbut sleep. Do you expectme to worry aboutbadconditionsin the village?”(el Katshaet al. 1989,p 25).

Local perceptionsof major water and sanitation problems.In orderto assessperceivedlocal needs,atthebeginningof the researchprojectvariousgroupsof villagerswereaskedhow they would characterizethemainsanitary problems in the village. Group meetings with villagers,observations,andmterviewswith individuals from different social groupsinthe community revealeda consensusin their perceptionsof environmentalsanitaryconditions. In bothvillages the disposalof sullageandsolid wasteinstreetsandcanalsrankedasthe mostseriousproblem,followed by improperseptic tank evacuation. In Babil, thepollutedstretchof the canal that runsthroughthe residentialarea,and the lack of an appropriateseweragesystemwerealso cited. In Kafr Shanawan,the high groundwater table,and theassociatedspreadof highly pollutedmuddypatchesandstagnantwaterin low-lying areaswereseenas seriousproblems.Villagersbelievedthat therewaslittle they coulddo to solve theseproblems,and thus did not act to solvethem. Even thebettereducatedresidents,suchas the teachers,sharedothervillagers’ perceptionsof environmentalproblems,and thought that thegovernmentwasresponsiblefor solvingvillage sanitaryproblems. The roleof thevillagers,as oneof theresidentsstated,“is limited eitherto submittingpetitionsand complaintsand/or contributingmoneyupon the requestof thelocal council”.

17

Local Administration and Iktanigeinent

The structure of local administ-ation. The action/researchprojectworkedclosely with the local administrationwhich overseestheprovisionandmaintenanceof local amenities.including those related to health and theenvironment. Beginning in 196G. a new systemof local administrationwasintroducedinto Egypt; it has heen regulated.most recently in 1988, bylegislationdirectedtowardsa gradualciecentralizationof the highly centralizednationaladministration. The lowest level of local administrationin Egypt isthevillage area,which may consistof a mainvillage, qaria urn, andperhapsoneor more satellitevillages,qaria tab1~a(in colloquial Arabic kafr), andhamlets,ezab. The village units aie groupedtogetherto form a district,markaz (pluralmarakaz);the rnarakaz are groupedtogetherto form provinces,or govemorates,rnuhafza (p1. muhafzat).

All village areashavea Village Council which consistsof an electedPopular Village Council (PVC) and an ExecutiveVillage Council (EVC).TheEVC membersaresalariedcivil servants,who neednotberesidentsof thevillage areasin which they work. According to legislation,the ExecutiveCouncil isresponsiblefor the maintenanceof local servicessuch aswaterandsanitation,as well as overseeingagriculture, health, and the supply ofsubsidizedcommodities;it hasa budgetto pay staffanda smalldiscretionaryfund topayfor specialneedsrelatedto theupkeepof thevillage.

TheelectedPopularCouncil, which consistsof village residents,actsas achannelfor requestsfor servicesfrom villagers. Villagers seekingfor thedevelopmentof facilities, or for maintenanceandrepair, must direct theirrequeststhroughthePopularCouncil~otheExecutiveCouncil.

Many decisionsat thevillage level needto bereferredto the rnarkaz aridthe govemorate;largeprojectsmustbe referredto the relevantministry inCairo. Decision-makingandauthority arehighly centrahzed.Thereis usuallymore direct interaction and communicationbetweenthe officials of therespectivedepartmentsat thema,kaz level andtheExecutive/PopularVillageCouncilsthan betweenthe governorateand the lower levelsof the hierarchy.Most officials at the governoratelevel viewed their role as that of policymakersfor theentiregovernoratc.while the staff at themarkaz and villagelevel havea more purely managementrole. At all levels, managersandpolicy-makersgenerallyadheretobureaucraticproceduresthat appeartediousandunnecessaryto outsideobservers.

Babil is a mothervillage, with its own central Village Council. incontrast,Kafr Shanawanis a satellitevillage with two electedrepresentativeson thePopularVillage Council basedin themothervillage. As it is adjacentto the mothervillage Kafr Shanawanusesthe servicesin that village - theagnculturalcooperative,veterinary serviceand Community DevelopmentAssociation- andenjoys readyaccessto theVillage Council.

18

Management systems responsible for environmental issues.The rolesandareasof responsibility of different local bodies responsibleforenvironmentalissuesneededto beidentifiedso that anyproposedinterventionscouldbechannelledthroughtheexistingadministrativehierarchy. Interviewsearly in theprojectrevealedthat responsibilityfor theseactivities is dividedamongdifferentdirectoratesanddepartmentsat the govemorate,markaz,andvillage level. Figures 1, 2 and 3 show the managementstructurein threeseparatesectors;piped water andhandpumps:irrigation canalsand the smallprivately ownedmesqa-s,canalswhich serveindividual farmers:and healthservices,educationand training in healthpromotion. Any activity requiringapproval above the village level must deal with a multiplicity oforganizations,in which lines of authority are not alwaysclear cut. Forexample, the Housingand Public Utilities Departmentis responsibleforbuilding and maintainingpiped water supplies,but not for installing andreading water meters. The Public Works Departmentat the markaz levelsupervisestheclearinganddisinfectingof main canals,while thevillage levelagricultural cooperativesupervisesthecleaningof the small, individually-ownedmesqa-s

Administrative staffregardedthemain constraintsfor local administrationaslackof materialandfinancialresources,andof qualified andcompetentstaff.Forexample,the directorof the ,narkaz level HealthDepartmentcomplainedthat the sanitanans,who often live far from thevillages they are supposedtoserve,only went to thevillages in emergencies.He also said that, as eachschool health visitor was responsiblefor severalschools,she could notproperlysuperviseall of themeffectively.

TheMinistry of Social Affairs assignsto different village servicesectorsthe public servicetrainees,femalegraduatesundertakinga yearof obligatorysocial service in their home villages after graduation. In the two studyvillages,thesetraineeswere involved in a numberof theprojectssupportedbythe action/researchprogram. The Ministry of Social Affairs is alsoresponsiblefor overseeingtheactivities of all local socialanddevelopmentalorganizations,which mustbeformally registeredwith govemmentauthonties.

19

FIGURE 1: MANAGEMENT RESPONSIBILITY FOR SUPPLY FR(JI PIPED WATERSOURCES AND HANDPUMPS

GOVERNORATE LEVELExecutive and Popular Council

—Sets policy and plans—Allocates funds

Housing Directorate—Builds and maintainswater tanks

MARKAZLEV L

Housing Department—Builds, maintains

village tanks

Water

Executive & Popular Council—Fxecutes work olan set

at governor’ate level—Monitors execution of

work plan at villagelevel

of Roads & Bridç?ives requests

for pipelines undermain paved roads

—Installs water meters—Builds, maintains,

Collects water use fees

Reports to Council

FIGURE 2: MANAGEMENT RESPONSIBILITY FOR IRRIGATION CANALS

Directorate—Monitors disinfecting

and clearing of canals—Enforces law 48 to prevent

pollution of canals

Executive and Popular Council—Sets policy and plan—Allocates funds

Executive and Poeular Council—Esecutes work plan set at governorate—Monitors execution of work plan at

village level

Public Works Department—Supervises of work

plan at village level—Supervises disinfectin

8 clearing of canals-Enforces law 48

Endemic Dise’ase UnitI -Programs to clear

j infested canals1 —Tests snail samples

Agricultural Cooperative—Supervises clearing

of canals-Clearing the privately

owned miskas

irrigation c!anals—Collects snails—Returns samples

to Health Directorate

GOVERNORATE LEVEL

Public Works A Irrigation

t~)

Health Directorate

MARKAZ LEVEL

VILLAGE LEVEL

Liaison Offices in eacru Markaz

Executive & Popular Council

FIGURE 3: MANAGEKNT REPONSIBILITY FOR HEALTH SERVICES AND TRAININGIN THE AREA OF HEALTH PRIJ4OTION

GOVERNORATE LEVELExecutive & Popular Council

ReceTvms reports fran Health Directoratesto coordinate activities with various dept.

HEALTH DIRECTORATE

Endemic Diseases Unit Nurses Unit School ealth Unit

Health ducationSection

MARKAZLEVELExecutive & Popular Council

—Receives reports Fran Health

HEALTH DEPARIMENTFi~cprcscntatf~ofálY[J~.tc ~rc to:

-execute work plan set at rvernorate level1

-report back to units at governorate level-ennitor execution of work plan at village

level

Executive Popular Council-Supervises activities of

VILLAGE LEVEL different units

HEALTH UNITin Mother Villa

—Carries out nationavaccination campaigns

—Maternity and child care-Outpatient clinic-Bureau of vital statistic

1’jI

Preventive Health Care Unit

Sanitarians Improvement of Sani tavySection Conditions Section

School Flealth Visitor Sanitarian 1(All Male)

Empowerment of Villagers

At the beginning of the project the researchteam exploredlocal people’sperceptionsabouthow to bring aboutchange in environmentalconditions.Most of the villagersexpressedfeelingsof helplessnessand fatalism. Thisindicatedthe needfor empowerment,andalso highlightedtheproblemswhichmightbeencounteredin attemptsto bnngaboutchange.

Similar views aboutbnngmgaboutchangewere expressedby all womenandby village leaders.As onewomansaid:

Yes,we are aware.But what can we do aswomen? We can onlycomplain to our husbandswould in turn complain to the villagecouncil,andnobodyseemsto listen to our complaintsor do anythingabout it

Anotherwomanclaimedthat:

Wekeepwriting complaintsto the village council and even to theofficials in thegovernment Wereceivethe usualanswersTherearenofunds,suchprojectsarenot includedin the budget

A memberof thePopularVillage Council, supposedlyelectedtorepresentthe mterestsof thevillagers,claimedthat~

The village councildoesnotask womentheir opinionsanddoesnoteven considertheir requests The mendo notpay muchattention towhat womensay becausewe know what is the best women mustabideby ourdecision

Thevillagers as a wholeappearto lacka senseof commoninterest. As acommunityleadersaid:

What rules among the peopleis personal interest. Nobodycaresaboutcommunalneeds Theyonly meetto furtherpersonalgoalsand to acquiremonetaryor materialincentives Theyare used tohaving the governmentsolveall their problemswithout consultingthem

Most groupactivities in the village are segregatedby sex. Althoughwomen cooperateinformally in many activities, they have not developedformal groups to support their common interests. Activities sponsoredthrough the Village Council. such as the Community DevelopmentAssociation,supportedwomen’sactivities suchas craftsandnutrition,butnot

23

water andsanitation. The neces~i1ycii official supportfor organizationalactivities hascontributedto this çassnity, and to the belief that any positionaction “is the responsibilityof the government”.

It was clear that the village organization,especiallyin Babil, wascharacterizedby lackof communicationbelweenvillagersanddecision-makers.Hence,nothinghadbeendoneto :Inprovethe poor sanitaryconditionsin thevillage. In neithervillage did the ExecitiveVillage Council mitially considertheseconditionsas a severeprobiem Iriat might havea direct bearingon thevillagers’ health.

The mainbamerto effectiveaction., asseenby membersof the ExecutiveVillage Council. waslack of materialresources.However,the councilswereunaware of some possible solution:~ Ic their dilemma. They failed torecognizethe needfor, andavailability of, competenttechnicalassistancetoidentify the most feasible and cost-effectivesolutions to environmentalproblems. More importantly, they Jailed to recognizethe importanceofcommunicatingwith andwinning the supportof the villagers,who could helpto identify specialneeds,andparticipaLein theprocessof solvingproblemsbyraising funds andcontnbutingtheir labor.

Preliminarydiscussionswith villagersaboutthe kind of environmentalproblems they experiencedshowed that they possessedknowledgeandawarenesswhich they could sharewith the local administrationandwith theresearchteam. Forlocal empowermentto workeffectively, local peoplealsoneededto learnhow to work together,throughnetworksof kin andneighborsand formal local organizations.From early on in theproject, it also becameclear that, for their part, bothv3llagers andresearchersneededto developstrategiesfor working with local staff in order to bring aboutdesiredchange.This positiveview of the possibility of dialogue,and its benefits,challengesthe opinion expressedin the much of the literature that the relationshipbetween governmentofficials and villagers in Egypt is adversarialandcharactenzedby mutualmlsundeistandilLg(seePalmeret al., 1988; Adams1986).

24

CHAPTER THREE

INTERVENTIONS

Introduction: Identifying Interventions

This action-researchproject was directed towards mobilizing villagers,especially women, to take the initiative to improve local sanitationconditions--toensurea reliableflow of clean andaccessiblewater,adequatesanitationanda clean environmenL Suchactivitiesare alsoan essentialpartof any programto of improve hygiene practices. For women’s knowledge,beliefsandpracticesaboutwaterandsanitationhavedevelopedin the physicalsetting of a particularvillage, andonecannotexpecttheseto changefor thebetterif physicalconditionsdonot improve.

In accordwith the action/researchapproach,villagers,working with theresearchteam,were encouragedto identify environmentalhealthproblems,andfeasible solutions. Once the villager’s had expressedtheir awarenessofenvironmentalproblemsof sewage,sullage and solid waste disposal,theresearchteambegan to discussmorespecific issueswith them. As a result,thevillagers identifieda numberof specific needsandrelatedinterventions.The simplestintervention,in Babil, was therepairandmaintenanceof brokenpublic standpipes;a laterfollow-up activity in this village involved installinghandpumps. The secondintervention,also in Babil, involved a numberofstrategiesto solve the problem of a pollutedcanal, including attemptstointroduce a sullageand solid waste disposalsystem. In Kafr Shanawanattempts to lower the ground water table eventually focused on thecommissioningof a feasibility studyfor a piped drainage/seweragesystem;this projectwasongoingwhen the formal researchprogramcame to an end.After thesevariousinterventionshadbeenpursuedfora year,the researchteamdecided to establishvillage committeesto find out if they could help tocompleteandsustaintheseinterventions.

Throughoutthe activities,the researchteammet weekly with womenandmen in the villages, and with local administrationauthorities. As theresearchersactedpurelyasfacilitators,thedirectionof theactivities wasguidedby the village womenandmen andby theresponseof the local officials. Theresearcherskept detailedfield notes of the meetingsabout each set ofinterventions;thesewerelatereditedandtables werecompiledshowingthetimeframefor eachactivity, andtheprocessesinvolved in the negotiations,asshown in Figures4 and5. These meetings were recorded, in all their tediousand time consumingdetail, in order to explore the processesinvolved inmaking decisionsand implementingthem. This crucial aspectis easilyoverlookedas reportsoften focus almost exclusively on theresultsof the

25

activities,ratherthan lookingat h~w tt eseresultswereachieved.Wecanlearnfrom the processas,in thecontex cf Ii is researchproject, thejourneyis moreimportantthan the destination.

Repairing Public Standpip~s

Action. In Halayla, one of the poorestneighborhoodsin Babil, villagewomenwho did not havehouseholdcoiinectionsindicatedthat therepairof abroken standpipewas a priority for hem. In late February 1987, sevenwomen attendeda meeting with the researchteam at a housenext to thedefectivestandpipeandoverlookinga badlypollutedcanal. The womensaidthat theyunderstoodthat the Village Council would notfix the standpipe,asthe work wasnot includedin their work plan and therewasno moneyfor theactivity in thebudget. Encouragedby the researchteam,the womenresolvedthat, as the standpipewas vital for their daily activities, they would raisemoneythemselvestorepairit andincreasethenumberof taps.

Over the next few weeks the women found out how much the repairwould cost andcollectedmoneyfrom local householders.Thehusbandof anactiveinformal local leader,the localtraditionalmidwife, ordaya,consultedaplumberaboutthecostof fixing the st~uidpipe;he estimatedthe cost at L. E.100 (100 Egyptian pounds). The local popular council representativecontributedmoneyto the project,andeocouragedotherneighborsto participatein theeffort.

When the researchteam met w:th the ExecutiveCouncil, the villageofficial responsiblefor thepiped water networksaid he waswilling to repairthe standpipetaps,as this was, in fact, within his domainof responsibility.The womenwillingly agreedto his requestthat they clean theareaaroundthestandpipeanddig thedrain to the canal. Theysooncompletedthis task. Oncethe standpipewas in use,it becameclear that the drainagechanneldid notpreventthe immediatesurroundingsof the standpipefrom getting muddy.Thusthewomenheldanothermeeting,at which theyagreedthat onewoman’shusbandwould bepaidLE 7 to tile theareaaroundthe standpipe.A detailed,chronologicalaccountof all the stepsfollowed in thesuccessfulinstallationofthis tap is presentedin Figure 4, including the activities which persuadedallneighborhoodwomenof the needfor thestandpipe.

26

Sevenwomenattendeda meeting held at a houseover-looking pollutedcanal(PC)& SP

- Oneof the womenraisedtheproblem of closmgdown thestandpipebecauseof a breakin it

- Women explained that theVC will not fii the SP as itis

not included in its work plan.- As the SP is basicto womenas a major source of water,efforts will be concentratedto raise raise moneyto repairthe SPand increasethe num-ber of taps- A nearbyresident(auni-versity student) objectstothe repair of the SPdueto thenoisewomen make whilefetching water RT stressedt

women that they are the onesto take action and participatecollectively in solvingtheir problem.

(ResearchTeam)RT arranged formeeting the com-ing week to furthediscuss the issue.

23/2/87

FIGURE 4PROCEDURES INVOLVED IN REPAIRING A STANDPIPE

Date Villagers’ Participation Role of Policy Makers IssuesDiscussed Follow up Comments

—.1

Date Villagers Participation Role of Policy Makers IssuesDiscussed Follow up Comments

23/2/87 Eight womenattendedRT &consultantsat onehouseholdoverlooking PC

- Womenreported that thestudentapprovedtherepairothe SF- Husbandof midwifewillconsulta plumberas ;o theexpensesof fixing SP- ConsultantsuggestedthateachhouseholdcontnbuteLE I including RT whoarefloW v!llage ressdents~

- Information ab-Out SPexpenseswill be reportedtoRT- A womanwill bein chargeof rais-mg moneyfromhouseholds Resulwill besharedwillRI

l 113/87 A groupof womenmet at PC -WomeninlormeciRI aboutrole ofRPVC.- RPVCexplainedthat totalcost will reachLE 100 to(a) install 4 taps, (b) buildafence aroundSF,(c) re-novate tap standing,(d) re-build SFfloor with tile

LE 40hasbeen raisedsofar- Womenreportedto RT thatthey went to RPVC to notifyhim aboutactivities He con-trrbuted moneyin his capaci-ty asa village member&

- More money is C~crequiredto meet women noti-expensesand this fled RT thatnecessitatesap- a disputebrokeprachinghouse- out betweentheholds which did no host of thesecontnbute gathenngs.andRT will arrange thosewhowere

for a meetingwith wereagainstre-womento Thither panngS.P.activities Themidwife

defendedtheproject& thewomen explai-

— ned that all this

- Headof VC explainedthatheapprovestherepairof SF& thathe told oneof RPVCto provideall neededes~uip-ment (taps & pipes).- RPVCexplainedthathedidnot receiveanything & thathehasbeenafterheadof VCbut in vain- RT sharedwith RPVCreno-vation neededatSFasarticu-lated by village women- RPVCexplainedthat vil-lagehaveraised LE 53 whic]is not enough

- Discussingwith family op-posing fixing SF its import-anceto village women Vill-agersshould cooperatetosolve their problems- The woman raisingmoneyfor SPexplainedthat shefacedlots of problemscollecring more moneyassomepeople areantagonistic.• Womenarenotified aboutactivitsessofar. Residentsofof otherneighborhoodsex-plainedthat after fixing thisSPeffortsshould beconcen-trated to repair theonelocat-ed m their neighborhoodOneof the women is willingto be in chargeof collectingmoneyandsupervisingtheSPin termsof up-keep.Asupplementof LE 13 hasbeen collected

- Onemantoldthe woman inchargeof coll-ecting money‘Why don’t youmind yourownbusiness ThisSFbelongstothe gov & theyshouldfix it Iwill not payapenny for it”

His wife laterapproachedthewoman& gaveher LE 1 with-out telling herhusband

16/3/87

Date Villagers’ Participation Role of Policy Makers IssuesDiscussed Follow up Comments

11/3/87 told otherneighborsto par-ticipate in theefforts aswell

is to the benefitof the village& its people

- Meetingwith thefamilywho opposefixing SF- Meetingwith thewomanresponsiblefor fund raising.- Meeting with a groupofwomen

- RJ’VC will con-sult about renova-tion Costsof SP- Arrangingforcoming weekmeetingswithwomen

Date Villagers’ Participatson Role of Policy Makers IssuesDiscussed Follow up Comments

23/3/87 - RI met with womenfromHalayla neighborhoodwhohave benefittedthemostfrom theSF- men, women & youth gath-eredatSP while it is beingcleanedup

- RI went to seeheadof VCbut hewasnot there- RT met with headof pipedwaternetwork& presentedthe issue The latter explain-ed thathe is willing to dothejob on condition that theSPbe cleaned- RT met with RPVCatTala t

to discuss whatcanbe dooe- RYVC & headof pipedwaternetu’ork gatheredatSP

- Women cleanedup theSParea& dug the drainto thecanalfrom SF- RPVCpromisedto supplybncks& sandto level theground& build a fence- RT discussedwith womentheimportanceof their effortto maintain the SP.

- RPVCwill sup-ply matenaltocompleteletere-novatiovation-Womenpromisedto be responsiblefor maintenance&up-keepof SP

i

- Women cameto realizetheimportanceofthe SPin theirlives & theirability to actcollectively tosolve pressingneed “TheSPbelongsrc’ usall Wecan’tdo ‘asthoutWe sufferedalot dunngthelast penodwhen it wasbroken

26/3/87 - Meetingwith 4 womenwhohelpedcleaning up theSP &who areresidentsof Halaylaarea

Womenexplainedthat theyhaveparticipatedin raisingthenecessaryfunds& clean-ing the SFbecausetheyaretheoneswho makemostuseof it Hence,they will makeall effortsto keept it clean

Date Villagers’ Participation Role of Policy Makers IssuesDiscussed Follow up Comments

8/4/87 Meetingwith a groupofwomenat SF

- The womenexplainedthatthe SF is functioningwell,Theproblemnow is thegroundof theSFthatneedsto be tiled, sincethemuddygood whenmixed with waterbecomesvery dirty- Onewoman’shusbandoffer-his labor to reconstructtheground

Arrangementswillbemadewith RPVand thelaborertofix thefloor of SF

13/4/87 RPVCmet with RT Thegroundof SFwas reconstruct-edwith tile with thehelpofonewoman’shusbandwhowaspaidLE 7

At first, some local womee \‘erc skepticalof the benefits of thestandpipe. Onewoman,a univcrstt) graduatewhosehousewasnext to thestandpipe,saidshedidnotwantt te st~nd~nperepaired,becauseof thenoise thewomenmadewhile collectingwer. She laterwithdrew her objectionwhenconcernedwomen explainedthat wnmen who, unlike her, did not haveahouseholdconnectionsuffered-.vlier they had to collectwater from a moredistantstandpipe. Otherwome i latercomplainedthat they did not want tocontribute to the cost of repairing the standpipe. The chairmanof theExecutiveVillage Councilexplainedto Item that lie approvedof therepairofthe standpipeand had askedthat al neededequipment,taps and pipesbesupplied. The womenin the neightxwhoodgraduallybecamemoreawareofthe importanceof the standpipe.Oneman had told the womanin chargeofcollecting the money: “Why do,z’t you mind your own business Thisstandpipebelongsto the governmentand theyshouldfix it I will notpay apennyfor ii “ However, his wife later contributedLE 1 without telling herhusband,becausesherealizedthat thestandpipewasimportantfor herfamily.

Womenin an adjacent neighborhood, who wanted to follow theexampleof the local womenin Halaylaandrepair their local standpipe,facedsimilarlocal opposition. Someof the neighborhoodwomensaid:“Let the universityfix our standpipe.” Otherssaid: ‘We wantwaterconnectionsin our homes,sowhy shouldwe careaboutthestandpipe’.” In spiteof this opposition,womenin this neighborhoodheld an meetrng anddecidedto collect money for therepairof thestandpipe. At a meeting thefollowing week, the womenwerediscouragedbecausethey hadnotbeenableto collectany money,andwereoffendedby remarksmadeby those who refusedto cooperate. No furtheraction wasplanned. The researchlearntold the womenthat whenevertherewasa will amongtheneighborsto actcollectively to fix their standpipe.theywould be willing to help theni ai ticulate their ideas and implementanyactivities.

Fourmonthslater, theVillage Council beganto renewthe piped networkfor the whole village andcut off all piped water suppliesfor two weeks,forcingeveryoneto rely on handpumps.However,somepeoplehying next tothe repairedstandpipetook theopportunity of thewater cut-off to submit apetition to the Village Council to closedown the standpipe. The concernedwomenwho hadbeenresponsiblefor gettingthestandpiperepaireddecidedtotake action. As onewomanexplained: “We could not standstill until theycloseddownthe standpipehis basic /0 useand we workedhardto repair it

last time We cannotgive tsp eosily” The women went to the PopularCouncil andaskedfor their help to keepthestandpipeoperating,to link it tothenew pipenetworkandbuild a fenceanda cementstandingto putthe watercontainerson while drawing water. Two weekslater the standpipewasworking again.

32

When the water was turned off, the women living aroundthe secondstandpipe,which was still not functioning,realizedthe importanceof thestandpipeand held a meeting to discussthe matter. The main actor inrepairing this standpipewas a respectedelder at the mosque. He wassuccessfulin collecting the money,as he suggestedthat thepaymentcouldbelikened to zakat, theIslamic obligation to give alms,and that thestandpipecould beconsidereda sabil,fulfilling a sacreddutyto providewater. He usedthemoneythe buy the tapsandpay theworker to install them and to connectthestandpipeto the new pipe network. He bypassedtheVillage Council, ashe claimedthat working throughthem would wastea lot of timeandachieveno results.

Results. Within six weeksof the first meetingbetweenthe researchteamand the villagers the first standpipewasworking again. A few weekslater, thework on thesurroundswascompleted.Thevillage womenagreedtobe responsiblefor the maintenanceof therepairedstandpipe.Whenthe pipenetworkwasrenewed,womenactedindependentlyof the researchteamto makesure that the standpipewas linked to thenew networkand further improved.Thewomenwerevery proudof their ability to bring this standpipebackintoworking order. Theyhadlearnedhow to work with thePopularandExecutiveCouncil membersto achievetheseends. A good groupof interestedandenergeticyoung women took the initiative and guided the activity. Thisstandpipebecameamodelof collectiveaction in the community.

In activities leadingto therepair of the secondstandpipe,the formal roleof theresearchteam waslimited to the first meetingswith concernedwomen.However, the womenwereencouragedby the successof womenwho actedtogetherto repairthefirst standpipe.

Handpump Installation

Background. Someareasin the two studyvillages weresituatedtoo farfrom thepipednetworkto haveadequateaccessto this protectedwatersupply.Thus,aspartof phaseII of the researchproject, lastingfrom September1988to August 1989, a new kind of handpump,delivenngpotablewater, wasintroducedin one study village. Thesehandpumpsusepolyvinyl chloride(PVC), which is light anddurable,for all moving partsand for the cylinder.The particulartype of handpumpselectedwas oneof severalbeing producedandtestedat theUniversityof Malaya,undertheauspicesof IDRC, which wassponsoringthe action/researchproject. A memberof the researchteam,asociologist,wassent to Malaysiato be trainedin handpumpinstallationandmaintenance.

The handpumpswere to be installed,and the efficacy of VLOM, villagelevel operationandmaintenance,testedin the village. This conceptinvolves

33

manufacturingthehandpumpsin the :ountry of operationin order to ensuretheavailability of spareparts; trainirg a villager to maintain andrepair thehandpumps,which needto berobista-ui reliable,andcosteffective,comparedto otherwatersupplyoptions(see Arl soioffet al. 1987,Chapter1).

Theresearchteamanticipatedthai thesehandpumpswould be useful,safeand low costwater sourcesin areasol villageswhich weredistantfrom pipedwaterlines andthereforenotaccessibleto aprotectedpipedsupply in theformof householdconnectionsor public stamipipes.In theseareas,householdersalreadydependedon privatelyownedFandpumps,which werelocally madeandinstalled,and maintainedby their owners. They were locatedeitherin thehosh,courtyard,of themud bnck houses,or alongthecanalbanks. As thesewere shallow suctionpumps, they only tappedthe upperstrataof groundwater,which mightbepolluted.

The village of Babil was identified as a suitable village for theexperimentalprojectas 12 of the 35 privatehandpumpsin the village weresituatedin areasof thevillage wheretherewasno piped waternetwork. Thewaterfrom someof thesehandpumpshadbeen foundto havean unacceptablyhigh level of fecalcontamination(el Katshaet al. 1989,33-7). Theseprivatelyownedhandpumpswerenot regulatedby the authontieswith regardto waterquality or location.

Althoughnegotiationswith the villagers beganin September1988.thepumpsdid notarrive until July 1989. Thefirst pumpwas installedin August1989, towardstheendof theprojectpenod.However,theprojectilluminatedthe generalissue of community participation,and the specific issue of thefeasibility of this kind of handpurnpin theEgyptianvillage settings.

Preparations for installatiou. The researchteam first discussedwith villagers the identificationof possiblesitesfor handpumps.andthe waysin which they might contnbutetowa~clstheir installation. At the sametime,the teammembersmadea surveyof the pumpsalreadyusedin thevillages,includingsuchissuesasthe costof the pumpsandwherethey wereobtained:the costof installation: thedepthof pumps,andrepairandmaintenance. Aconsultantfrom theUniversity of Malayasuggestedthat, becauseof thehighgroundwatertable,theUNIMADE Mark111 suctionhandpumpwould bemostappropriate. This pumpis relatively easyto operateandmamtain,anddrawswater from a 30 metertube well, comparedto the local handpumpssomeofwhich wereonly 10-15 metersdeep.

Severalmeetingswereheld with villagers,representativesof thePopularCouncil, andwith the headof the Village Council, to discusstheadvantagesof thePVC pumpsover the local type, theestimatedcostsof constructionanddrilling thewells,andthe criteriatobeusedin determimngthe location for thehandpumps. At that time, it was also deemed necessary to use local

34

contractorsto dnll the wells andinstall the handpumpsm order to ensurethesustainabilityof theprojectafterthe researchteamhadwithdrawn.

For this experimentalhandpumpprojectthe units weresuppliedby theresearchcenterat the University of Malaya, but PVC piping for the welltubing hadto be obtainedlocally. A UNICEFengineer,who wasworking oninstalling handpumpsin Upper Egypt. advisedthat the team contacttheNational Plastic Company(NPC) to find out if they were willing tomanufacturethe PVC pipesto the specificationsrequiredfor the tubewell.The NPC was willing to do this on an experimentalbasis,anddonatedthefirst set of PVC pipesandscreenasa gift to the projectand villagers.Theysenta representativeto the siteto follow-upon the drilling procedures.

A committee,consistingof village leaders,the chairmanof the VillageCouncil, delegatesfrom the Village PopularCouncil, and theresearchteamidentified the sitesfor the handpumps.The criteria for the location of thehandpumpincluded: the pumpshouldservea largepopulationandshouldbeinstalledin a neutralarea,notcloseto the houseof anyprominentvillagers;and the placechosenshouldbe acceptableboth to the villagers and to theVillage Council. However,the committeedecidedthat the first handpumpshouldbe installedin the centerof the village, since it wasfor expenmentalanddemonstrationpurposes,and the costwould be coveredby theresearchproject. Written permissionfrom the Village Council was necessarybeforedrilling couldbegin,as the sitewason governmentland.

No contractorspecializingin drilling deepwells couldbe identifiedin thevillage, but a contractorfrom the same markaz was approachedon therecommendationof the villagers. After severalmeetingswith the contractor,anddiscussionsat the governoratelevel, it transpiredthat the contractorwasnotregisteredwith thegovemorateandthereforehisservicescouldnotbeused.Membersof thevillage committeethuswidenedtheir searchfor anappropriatecontractor. No contractorscontactedhadany experienceof working withplastic tube wells, as they had not been usedpreviously in this area.However,thefirst contractorhadaskedfor somemodifications,andtheNPChad willingly readjusted the socketsof thepipesas recommended.

The role of women. The researchteamapproachedwomenin severalvillage neighborhoodsto sharein the processof handpumpinstallation.Dunng home visits, team membersand public service trainees(femalegraduates carryingout a year of obligatory public service activities in theirhomevillages after graduation),explainedthe advantagesof the PVC pump,its cost,andproceduresof installation. Womenexpresseda willingnessto betrained in the installation,use and maintenanceof the new pumps. Thewomenmembersof the village handpumpcommitteeinvitedotherwomenandmembersof theresearchteamto meetingsin their homes.

35

Results. Justbeforethe cc ii eleion of PhaseII of the researchproject.the first pumpswere installed hy thai time it wasalreadyclear that the costof a PVC handpumpand instalhitjiii was six times that of a traditionalhandpump.The main cost of thePVC pumpswasthe needto usespecializedwell drilling equipment. This i~nit usedby the conventional,shallowpumps: however, such drilling equipmei it mustbe usedif the pumpis to bedeepenoughto providesalewater i i addition,working with PVC piping isanunfamiliartechniquein thearea~Identifying specializedwell dnlling teams,who were bothlocal andapprovedby the authonties,consumeda largeamountof time.

A manualfor the operation,maintenance,and repair of the pumpswaspreparedin Arabic for the villagers :n chargeof maintainingandrepairingthesepumps. Withm thetime frame of the action/researchprojectit wasnotpossibleto monitor andevaluatethe I~andpumpactivity. However,membersof the researchteam are conlinuieg to evaluatereliability, durability,maintenancerequirementsand technicalperformanceof thesePVC pumpsatthe village level,andcomparingthem with pipedwatersupplies.

The PVC handpumpsdid provide safe water. However, given theconditionsin the studyvillage, wherepiped water was available,thecost ofinstallation was too high. The availability of piped water, which might beextendedto all areasof thedenselysettledvillage, meantthat womendid notconsiderthe installationof handpurnpswas a priority and they were thusnotmotivated to support the effort. The PVC handpumpsmight be moreappropriatein small,remotesatellile villages andhamletswith populationsofup to about500 peoplewhich were distantfrom pipedsupplies.Additionally,thehandpumpsmight beappropriateiii the small, dispersedsettlementsfoundin thenewly reclaimedareas.

Activities Related to the Polluted Canal

Preliminary discussions. In Babil. local peoplecomplainedabout thepollutedcanalwhich ran throughthe centerof the village; it was stagnant,smelled,and was full of garbagewhich attractedflies. At a preliminarymeeting,attendedby some of the v’omen who were trying to repair theHalayla standpipeon thebanksof the lX)lluted canal,theresearchteamagreedthat they would cooperatewith the local womento do somethingabout thisproblem

The researchteam arrangedfor a First meetingwith ten womenby thecanal. However, the daya, who was also active in efforts to repair thestandpipe,was too busy to carry out her promiseto contactthesewomen.The researchteam relied on othci in~crmalleadersto arrangefor the nextmeeting. Whenthemeetingdid gatherat thecanal,it wasjoinedby five menand the village representativeon the PopularCouncil. Thegroup agreedwith

36

the councilorthat thecanalhadlost its original function asan irrigationcanalsinceit now passedthroughanentirelyresidentialareaandno longerreceivedaregularflow of water. Therewassomediscussionasto whetherthebridgeandthepipe connectingthepollutedcanalwith the main canalshouldbe fixed toenablethe waterto flow again,or whetherthecanalshouldbefilled in.

The womenexpressedtheir concernthat, if the canalwas to befilled in, asullageandsolid wastedisposalsystemshouldbe developed;if this was notdone the.sullageandgarbagewould simply be thrown into anothernearbycanalandthe problemwould occuragain Oneold woman,reflectinganolderview of the canal,said: “This canal is the soul of our village, it keepsourhomes clean.” In contrast,a youngerwoman commentedon the poorconditionof thecanal:“It bringsdiseaseto our children” Thus rightfrom thebeginning,the activity involved threeactivities: (a) direct action to improvethe canal; (b) a sullagecollection service; and (c) a solid wastecollectionsystem.

Direct action to improve the canal. At weekly meetings todiscusswhat to do aboutthe canal,variouspossiblesolutionswere discussed.Therewasa suggestionto install a pipe and thencover it, so that it could notbepollutedby villagers. Subsequentdiscussionsfocusedon whetherto fill inthe canalentirely or removethe obstructionswhich preventedthe waterfromflowing freely. For thefirst time, village youths attendeda meeting. Theywere ready to help to fill in the canal,on the understandingthat they couldhavea soccerfield on thefilled area.Nothingcameof this initiative.

An importantweekly meetingoccurredon April 22, 1987,whena groupof ten men andwomenjoined the researchteam,consultants,the physicianinchargeof the village healthunit andthe secretaryof the Village Council, todiscussappropriatesolutionsto the village environmentalhealthproblems.The researchteamwasworking to raiselocal awarenessof the problems. Atthis meeting the physician,for the first time, becameawareof the healthhazardposedby the canal. Unfortunately,theheadof the Village Council didnot attendthis meeting. Villagers explainedthat: “He is not interestedinvillage affairs becauseheisnota village resident.”

The focusof activity then revertedto thequestionof filling in thecanal.The researchteamagreedto accompanythePopularCouncilrepresentativetothe IrrigationDepartmentat the ,narkaz level to discuss this issue, as nothingcould be done without the agreementof this department. The headof theExecutiveVillage Council was also invited to comealong. At the meeting,theIrrigation Departmentofficial agreedthat thecanalwas no longerusedforirrigation and that a technicalfault in the connectionbetweenthemain canaland thepolluted canalpreventedthe water flowing through The ImgationDepartmentagreed to raise the issueof filling in thecanalwith theIrrigation

37

Directorateat the governorate1ev ~1a~d themaikaz imgationengineerandtheheadof the Village Councilagreedo tleid a meetingat thepollutedcanal.

In order to fill in the canalapp o~al hadto be obtainedfrom farmerswhooncedrewwater from the canal icr I old irrigation. The village agriculturalcooperativehad a list of all loca pecile with rights to drawwater from thatstretchof the canal,and the local caoierativerepresentativeon theExecutiveVillage Council agreedto collec~die signatures.Unfortun~te1y,thefarmersconcernedfearedthat if they sig ied lie documentthe irrigation Departmentwould useit againstthem to reducetheir shareof the irrigation waterfrom thewhole imgationsystem.

The local governmentstafr wee slow to cooperatein these variedactivities; the chairmanof the ExecutiveVillage Council had not attendedmeetingsas promised,and had failed to meet with the researchteam on anumberof occasions.Thus, the researchteamdecidedto seekfor supportfortheseactivitiesat the governoratelevel. On October26, 1987, they met withthe DeputyGovernor,the Secreiaiyof the Governorateandrepresentativesfrom all departmentsconcernedat governorate,markazand village levels. Asa result of this meeting,the Secretarygave instructionsthat the variousdepartments.including village level authorities,the headof markaz Tala, theDirectorateof WaterUtilities at both governorateandmarkazlevel shouldcooperateto solve the problemof thepollutedcanal. The following day,theheadof markaz Talavisitedthe vilagu andmet theVillage Councilchairman,the headof the village agricultural cnoperativeandeight local men at thepollutedcanal. The markaz headthen sot up a committeeto investigatetheproblem,andproposesolutions. The committeewasscheduledto presentitsfindings in time for the consideralionof the village-leveldisbursementofUSAID fundsfor local development.

At a meetinglaterin Novemberl~187,a prominentvillagersaidthat if thecanalbridgewasreconstructed,ti-c remainingfarmerswould sign to approvethe filling of the canal. The group decidedthat money from the VillageCouncil sanitationfund could iii usedto reconstructthe canal bridge.However,as thevariouspartiesinvolved could not reach a consensus on howbest to do this, thefunds which i-ad beenearmarkedfor it~verereallocated.After this, attention turned to a ~~tiategyfor clearing the canal, rather thanfilling it in.

In July 1988, after more than eight monthsof meetings involvinggovernorate.rnarkaz andvillage ievel authorities,thedefectivepipe leadingfrom the main canal to the pollutec canal was fixed. In October,theagricultural cooperativecleanedthe canal and the water started to flowregularly. All the villagers,both wonien and men, werehappy to see thecanalclearedandwaterflowing again

Oncethecanalhadbeencleared,aid the garbagecollectionsystembeganto operate,it becameclear that ii was still necessaryto clean the canal

periodically. Thus,theresearchteamand formalandinformal village leadersdiscussedthe possibilityof developinglow-costequipmentto removegarbage,such as logs andplastic containers,from the canal. The smith who hadmanufacturedthe garbagecollection cartmadesome largeforks andheavyplastic netswith long handles. Two families, living at eitherendof the canalexperimentedwith the forks andnets. However, thesewerenot effectiveasthey were only designedto removesmall floating items,and therewastoomuch garbagein thecanal. A yearafter thecanalwas first cleaned,theprojectteam and informal leaderswent to the ntarkaz Agricultural Departmenttorequestthat the canalbecleanedagainfrom leftover refuse:within a week thecanalwascleanedat theexpenseof that department.

Sullage and solid waste disposal. From the beginning, manyvillagerssupporteda sullageand solid wastecollection systemin order topreventthe pollution of the canalsrunning through the village. A sullagedisposalsystemwould alsocontribute to lowering the overall groundwaterlevel in thevillage. The Village Councilhad the authority,indeedwas legallyrequired,to collect feesup to 2% of the rentalvalueof eachhouse,for sullageandgarbagecollection. However,here,aselsewhere,collectionof feesandtheprovisionof the serviceswas irregular; the local Village Council hadbeencollecting feesfor this purposefor the past two years without actuallydoinganythingabouttheproblem. Somelocal residentsclaimedthat thedisposalofsullageandsolid wastewasthereforetheresponsibilityof the Village Council,and that it was not appropriate for the villagers to take action--thusunderminingcommunityefforts.

In mid-April 1987, the researchteam anda group of womenand menvisited threeneighboringvillages to look at sullagecollectionsystemswhichwerebeing implementedby the village council or by privateenterpnse.Thishelped the group to identify possibleways of implementinga sullagecollection system. BetweenMay 11 andJune1, 1987, theresearchteam helda seriesof meetingswith villagers,therepresentativeof thePopularCouncil.and the man who wasresponsiblefor septic tank evacuationin the village,who owneda truck. Thegroup devisedan experimentalprivatelyrun sullagedisposalsystem, which was to operate in the most densely populated part ofthe village. However, no concreteaction about this proposedsullagecollectionsystemhadbeentakenby theendof theprojectperiod.

Although mostvillagers in the neighborhoodsupported,in practice,theidea of a solid waste disposalsystem, some villagers still expressedreservations.Theywereconcernedthat thesystemwould notoperateregularlyand that somepeoplewouldrefuseto pay themonthlyfeeaslong asthey hadaccessto a free dumpingarea,thepollutedcanal. As a generalstrategy,thevillagers agreedthat whatwas neededwasa mule-drawncartto collectgarbagefrom thehouseholderson a daily basis. A mule-drawncartwould becheaper

39

than a tractor. It would alsobeair t getcloserto eachhousethan a tractoras it would be ableto movethrc igh I ~enarrow alleys in the mostcongestedareaof the village. As an incenive, he researchteamagreedto providethecart. Thiswasmanufacturedby a Inca 1 sroithandwas readywithin six weeks.Theheadof marka: Talaagreedc su ply the village with amule to drive thecart; ten monthsandmany corn )tex negotiationslater, the mule wasmadeavailablefor theproject. Threenonti is later, theheadof theVillage Councilassigneda village worker to drive the cart, andfood and shelter wasprovidedfor themule. The solid wastedisposalsystemwas then readyto operate--oneyearafter themain outlinesof the sys~einhadbeenagreedon by the villagers.the researchteamand thelocal authoritiesas shown in Figure5.

In November1988,onemonthafter the waterbeganflowing throughthecanal,the garbagecollection systemwas finally initiated. For threemonthsthe systemworkedwell in theareaof the village closestto thecanal,whichwas kept relatively clean. However, l)rOblems soondeveloped. As thegarbagecollectorworkedon hisown,lie hadto attendto the mule himselfandcouldnot help childrenandwomen~ut their garbagein the cart. A request.via the ExecutiveCouncil, to haveau ertraworker on the cart wasrefusedbecauseof a shortageof laborersat the niarkaz level. Thelaborer graduallybecameless regularin his roundsand did not stop in all the village streetsasagreed,the villagers thought that the worker was noteffective becausehecamefrom thevillage andwasashamedof hiswork. This workerwasreplacedby a non-residentvillage council worker,who was no moreefficient, and thesystemgraduallybroke down. The women went back to their habit ofthrowing garbagein thecanal.

Results. Activities concernedwith the pollutedcanal,and the relatedinterventionfor sullageand solid wastecollection beganin mid-February1987. Although thecanalwascleanedandflowed freely, it wasunlikely thatit could be kept clean in the absenceof sullageand solid wastedisposalsystems. Villagers andlocal administratorsagreed,in principal, to a planforsullagecollection but no action wastaken By November,the solid wastesystemwas agreed on, and a year later thesystemstartedoperating;it workedeffectively for threemonths. The Villager Council complainedthat thesystemwas too costly: the mule was eating too much. Thus,the mule andcartweresold.

40

FIGURE 5TIME ALLOCATION FOR AN ACTIVITY:

IMPLEMENTING A SOLID WASTE DISPOSAL SYSTEM IN BABIL

ProposedIntervention ResponsibleBodies Starting Datesof Negotiations

WasAccepted Duration Not Accomp-lished- MamReasons

Manufacturing locally acartfor sohdwastecollecLion

Projet team,informal &formal village leadership

Dec 3, 1987 Jan 21, 1988 1 1/2 months

Purchasesof a mule topull cart

HeadofMarkaz Exec.V.C Nov. 19, 1987 Aug 1988 10 1/2 months

Solid wastecollectionstartedto function aftercart+ mule+ food &sheltermadeavailable& appointingone laborer

Village Council Nov. 19, 1987 Nov. 1988 12 months

Theneedfor anextralaborerfor garbagecol-lecLion

Headofmarka:, HeadofV C

Jan. 1989 ---- --- Proposalrefuseddueto shortageof laborersonthe inarkaz leve

Lowering the Water Table iii I afr Shanawan

Preliminary discussions.In the ‘~illage of Kafr Shanawan,the problemof the high watertablewastack eda the village level, as this wasa problemaffectingthe whole village. The ~Lgh v’ater tableresultedin thepondingofhighly pollutedwater at low lyng f:oints in the village, muddystreets,anddamphouses, especially those madeof mud brick. At thefirst meetingtheresearchteamdiscussedwith the village lraditional mayor(the omdah ) andtwo mosqueimains the importanceof involving the villagers in efforts toimprovesanitaryconditions. During thefollowing Fndayprayer sermontheimam discussedthis issuewith the largegroup of men present.

In late July 1987,village sanitaryproblemswerediscussedat a meetingattendedby fift) men after the Friday prayers. The villagers identified thesanitaryproblemasrelatedto the low elevationof thevillage,excessiveuseofwater, especially from flush toilets, in the absence of a drainage system.Villagersexpressedtheir willingnessto collectmoney to establisha drainagesystemin the village, and alsodiscussedthemore immediatepossibility ofintroducing a sullagedisposalsystem. Thus,right from the beginningof theactivity, therewere two facets to the problemof the high water level. Thelong term solution involved plans for the developmentof a pipeddrainage/seweragesystem. The short rangepartial solution wasto work forthe establishmentof a sullagedsposalsystemwhich would limit theamountof wastewater being thrown into t~iestreetsand canals--thuskeeping thestreetsandhousesurroundsrelatively dry andpreventingpollutedwaterfromenteringthe canals. A subsidiaryac:tvity hereinvolved the improvementoftheexistingsolid wastedisposalsystem

The long term approach. At the first general village meeting,inJuly 1987, villagers askedthe researchteam to contactan engineeringconsultantwho couldgive themadviceabouta drainagesystemfor thevillageThe consultantmeta monthlater with the orndah andaboutsixty villagers inthe village guesthouseadjacentto the mosque. After walking aroundthevillage, the engineersuggestedthata piped network could be establishedtoreducethe groundwaterlevel. Theexpenseof thisproposednetworkwould befar greaterthan any other interventionsuggestedso far, aboutLE 100.000.The villagers agreedto form a village committeeto further discussthisproposalandtoraisethenecessaryfunds, Theamountneededdid notdeterthevillagers,who pursuedtheproposaldiligently.

In view of the complexity of the proposedsystem,it becameclear thatauthoritiesat the marka: andgoven~orateshouldbe contacted.Theresearchteam met the Deputy Governoranc the Secretaryof the governorate,andrepresentativesfrom ORDEV (Organization for Rural DevelopmentofEgyptian Villages) and the Pu3lic Works and Imgation Directorateat the

42

govemoratelevel, the headof rnarkaz Shebmel Kom, and the Chairmanofthe Village Council. However, immediateaction was not possible,as nofurther drainageor seweragesystemscould be introducedin Menoufiabeforethe two pilot rural seweragesystemsin the govemoratehadbeenevaluated.Thus,the mostrealistic interim activity was to conducta feasibility studyfora drainage/seweragesystemwhich couldbe implementedat a laterdate. Theresultsof this meetingweresharedwith villagersafterFriday prayers,andtheyenthusiasticallyendorsedtheplan for a feasibility study.

The researchteamobtainedthe servicesof two environmentalengineerswho met with villagers,theomdah.membersof the PopularandExecutiveVillageCouncil,andrnarkaz andgovemoratelevel officials; the groupwalkedaround the village making an assessmentof requirements~A two phasesystemwas suggested;the first phasebeing the establishmentof a pipednetworkto reducethe high groundwatertable,and thesecondphaseaddingaseweragetreatmentplant andenlargingthe networkby supplyingindividualhouseholdconnections.The researchteamworkedwith the technical teamtocollect the necessarydata for the study, which was submitted to theengineeringconsultantin February,1988 Thereafter,the researchteamheldaseriesof meetingswith the engineers,andthe representativeof ORDEV inorderto obtain theapprovalof the Irrigation Directorate,and togetapprovaloffund allocationthroughthe Village Council in Shanawan.

The allocationof funds for the whole programwasa problem,as theVillage Council refusedto allocateall the availablemoney to a project forKafr Shanawan.a satellitevillage. At theendof November1988,a delegationfrom the village committee met the governor to obtain his support forintegratingthis projectinto the overall govemorateplan for the improvementof village infrastructure. The governorreferredthe questionto theMarkazExecutiveCouncil,and they met with the researchteam,the chairmanof theVillage Council. the local PCrepresentativeto discusstheir request.

Theresearchteamregularlykept the Village PopularCouncilinformedinwriting about all the proceduresandstepstaken,andsuppliedthem with allthe relevant documents. The Popular Council decided that they had noobjection in principal to the implementation of the project in Kafr Shanawan.However, therewere no funds availablefor the feasibility study from theannualbudgetwhich camefrom the govemorateandwasdesignatedfor theORDEV projects for the whole village area.Consequently,the ExecutiveCouncil refrained from submitting the feasibility study to ORDEV at thegovemoratelevelby theduedate. Thus,theymissedthechanceof integratingthe projectwithin the overall plan for infrastructuralimprovementsin thevillage area,andfinancingit throughthis budget.

In February1989,whenthe Kafr Shanawanproposalwasput to the votein the Popular Village Council, the two representativesfrom Kafr Shanawancould not muster enough votes to get the proposal passed. However, the

43

Popular Council agreedto support i plan to provide a piped systemandtreatmentplant for the whole ci th main village, as well as the adjacentvillage of Kafr Shanawan. Ji~th~i combined population of these twosettlementswas c 33,000peope, a fuil seweragesystemwas consideredfeasible.

The revisedfeasibility studyto ii dudeShanawanwould costLE 12,000.The villagers from both Kafr Shama~ian andShanawandecidedto raise themoneyfor this, and the engineeing consultantbeganpreparingthe plan forthe two villages. As a token of theii continuingconcernfor theproject, theKafr Shanawanvillage committee which had beensetup to raisefunds for theproject met with membersof the village Community DevelopmentAssociation,anddecidedtoopenabankaccountin thenameof theCDA tobeused to finance activities to lower the water table. The CDA was selectedbecauseit is registeredunderthe Minstrv of Social Affairs, and thuscanopenan account in the bank to servecommunityneeds.

Sullage and solid waste disposal. To initiate discussion aboutsullagecollectionin Kafr Shanawan,the iesearchteamsharedwith thePopularVillage Council representativeand a group of five villagemen the experiencesin two neighboring villages where sullagecollection systemshad beeninitiated. Thevillagerspromisedto contacta local man who owneda tractorto ask him if he would take chargeof the sullagecollection systemfor amonthly fee, tobe paidby all the villagers. BetweenearlyMay and theendofJuly 1987,severalmeetingswerehedwith the headof the Village Council,thePopularCouncil, andsomevillagers.

At that time, no villager wa~willing to takeon the responsibility for thesullagecollectionsystem. However, heVillage Councillater placeda tank inthe middle of the village, which was still beingregularly emptiedat the timetheaction/researchprojectended.

Theresearchteamalso encouragedthevillagers to continuethefalteringsolid wastedisposalsystem,whichTelied on barrelsplacedatvariousstrategiclocations throughout the village The village council garbagecollectoremptied thesebarrelsregularly and filled in low lying areasin the village.However,this systemcouldnotbe sustained,andit collapsedbefore theend oftheresearchprojecL

Results. At the time the project ended, the feasibility study for theseweragesystemfor Kaft ShanawanandShanawanhadbeenalmostcompleted.Villagersand local administrationstaffwereseekingfor funding to beginthislargeproject. Meanwhile,the sullagedisposalsystemwasbeing maintainedby the Village Council. These activities contributed to improvingenvironmentalconditionsin the village. Membersof the researchteam

44

continued,on an informal basis,to monitor the progressof thesevariousprojectsafter theendof theprojectperiod.

Village Committees

Introduction. Specialpurposevillage committeesto support the locallevel activitieswere introducedin phaseII of the researchproject,beginninginSeptember1988. The researchteam wished to testthe usefulnessof suchvillage committeesas anadditionalstrategyto supportthe waterandsanitationinterventions; to enhancethe sustainabilityof theseinterventions,and todevelopeffectivelocal level leadershipand decision-makingcapabilities.

Most committeememberswere selectedby community memberstorepresenttheir needs;a few were volunteers. This group, with a commoninterest in solving a pressingproblem or meeting a common needin theirhome area,were expectedto deal with theseproblemson behalf of thevillagers. Someof thecommitteesconsistedof both men andwomen,othersconsistedonly of women.

The major task of the village committeeswas to identify and monitorwater and sanitationactivities. Committeememberswereexpectedto makecontactwith policy-makersandofficials whenneeded,andalsokeepin touchwith the villagers and mobilize them to sharein activities by contributingtime, labor, moneyor ideas. In sum, the village committeememberswereexpectedto assumea leadingrole in instigatingandsupportingcommunityparticipation,and stimulating the villagers to work with them to identifycommonneeds,andto planandtakeaction to meettheseneeds.

The researchteamtestedtheviability andeffectivenessof different typesof village committees,thosebasedon a residentialclusteror neighborhood.and thosebasedon thewholevillage. Theyalso testedthe feasibility of usingpublic servicetrainees(femalegraduatescarrying out a yearof public serviceactivities in their homevillages),to supportthe activities of the committee.This group had alreadybeen trainedto work with the villagers as healthpromoters(seeChapterIV). They wereexpectedto follow-up theactivitiesofthe village committees,and to keeprecordsof their activities as part of themonitoringandevaluationprocess.

The formation of village committees. The research teamdiscussedthe ideaof establishmgvillage committeeswith different groupsofvillagers,and thepublic servicetraineesraisedthe ideawith villagersduringtheir home visits. They explained to villagers how a small group,representingtheir own needsandselectedfrom among them,could play apositiverole in solving their village sanitaryproblems. In the two villages,the majorproblemshadalreadybeenidentified by the researchteamworkingwith informaland formal village leadership;a seriesof formally established

45

committeeswas now neededto ~irLdon the initiativeswhich hadalreadybeentaken.

In Kair Shanawan,a singlev lIt ge-levelcommitteewasformed, to dealwith thepreparationof the feasblit r stadyrelatedto the high groundwatertable; it had 16 female and22 nile members. In Babil, therange of localsanitaryproblems,aswell as thefragiientedsocialorganizationof thevillage.resultedin the formationof threevillage committees,eachconcernedwith aparticularproblemin onevillage neighborhood.Onecommittee,consistingof 6 women,wasconcernedwith fixing a standpipe,andanother,consistingofsix women and four men,monitored a standpipeand the cleanlinessof theadjacentcanal. The third committee,consistingof four womenand five men,wasformedto supportthesolid wastecollectionsystem.

Membershipin the committeeswas opento all, regardlessof education,statusor sex. Themain criteria for selectionwasa willingnessto contributetime and effort to finding a feasible answerto village problemsand tofollowing up activities agreedon by the committee. Committeemeetingswerescheduledoncea month at a location agreedon by members. Not allmembersof the threesmallerBabil committeesattendedregularly,but therewereusually enoughmemberspresentto takethe requireddecisions. In KafrShanawan,meetingsof the single, largecommitteewereusuallyattendedbythe sameten women and fifteen men of a total initial membershipof 16womenand22 men.

The achievementsof the village committees. The villagecommitteeswere only in operationfor six monthsbefore the end of theresearchprojects,so their concreteachievementswerelimited. However,thevillage committeemembersin Bawl concernedaboutthepollutedcanalwereable to break the year-longdeadlock in discussionsbetweenthe localauthoritiesandvillagers. Theywere ableto geta programof actionacceptedwhichinvolvedclearingthecanalandactivatingthe garbagecollectionsystem,andthey helpedto motivatewomenandmenliving nearthecanalnot to throwgarbageinto it.

TheKafr Shanawancommitteeconcernedwith the feasibility studyforlowering the watertablewas formedaftercontactshadbeenestablishedwiththemarkaz andgovernorateadministration.Specificactivities of the villagecommitteeincludedpresentingthe caseto the governor,in November1988,and in June 1989 meetingwith the membersof the village CommunityDevelopmentAssociationandpersuedingthem to opena bankaccountin thenameof the CDA to collect money from villagers for the project. Theseactivitieswereongoingat the time theaction/researchprojectcameto anend.

46

Lessons Learned

The participation of women. Involving women in improving thesanitaryconditionsof their village was the main projectstrategy,as womenaretheroam usersof all waterfacilities,andareresponsiblefor thedisposalofusedwaterandgarbage.Plannersshouldnotunderestimatethecompetenceofvillagers, especiallywomen, on issuesthat relate to them directly. Theyknow best what might be feasibleandacceptable,and what is not likely towork. The majontyof the womenwereableto follow the discussionswiththe researchteam,and the formal meetings. The womenmademostof thesuggestionsconcerningtheproposedgarbagecollectionsystemin Babil whichwerelaterimplemented.

Women’s cooperationwas sought continuouslyfrom groups withindifferent neighborhoodsor on an individual basis. Both approachesprovedeffectiveandcomplementary.The focusgroup discussionsgavetheresearchteamthe chanceto listento women’sviews andsuggestionsasto how to copewith thesanitaryproblemsin their own neighborhood.

The successof repairingandmaintaininga local standpipe,showedthatwomenrealizedthe powerof collectiveaction. Suchaction is only possiblewhenwomenagreeona specialneed.Thewomensucceededin involving theirhusbands,and their representativeson the Village PopularCouncil. Havingput somuch effort into raising money,clearingthe site,andrallying support,andhaving seentheresults,the womensaw to it that the standpipecontinuedto function andmet their needfor cleanwater.

The lack of cooperationfrom women in the neighborhoodsin whichhandpumpswerebeing installedwasdue to the fact that the activity wasplannedin responseto researchneeds,not in responseto the needsof thewomen. The women did not considerthat new handpumpswere necessarywhenthey lived in a village with apipedwater supplywhich, they felt, shouldbeexpandedinto their neighborhood.

The morecomplexproblemof the pollutedcanalwasa difficult one forlocal peopleto work togetherto solve; interactingwith local andregionaladministrationofficials was tediousand time-consumingand therewere anumberof possiblealternativeinterventionswhich neededto be discussed.The womenwereprimarily concernedthat, if the canalwasfilled in, thereshouldbe a sullageand solid wastecollectionsystem. Thusthey weremoreactive in this area,than in theotherdiscussionsaboutthe futureof the canal.Similarly, becausethe problem of the high ground water level involvedconsiderableinteractionwith markazandgovernoratelevel officials, thisresponsibilitywas handledby the men in the village, although womenprovidedcontinualsupportandencouragement.

47

Fostering community par’~icipaiLion.The strategy for encouragingcommunity participationneedeL io e flexible andresponsiveto villagers’needs. The researchteam encctraged~illagersto share in activities in anyform they felt appropriate.Forexamdc,afterdiscussingthemakingof a cartfor garbagecollection,the village leaJer~andthe researchteamapproachedalocal smith who enthusiasticallyhelçad designand manufacturethe cartat alow price. Villagers’ participatLonin Lhe senseof contributingmoneyor laborwas lacking at first in this village selling. Gradually it increasedbecauseofthesupportof village leadersandoutsidecatalysts.

Villagerstendedto be individuakstic,andwere notconcernedwith groupaction. The feelingthat the “government’shouldberesponsiblefor all villagesanitaryimprovementsprevailed,and wasan obstacleto effectivecommunityparticipation. The researchteam soughtto identify and sustaininformalvillage leaderswho would foster group action,but time was neededforvillagers to internalizethe conceptof suchgroupactivities~The elementoftrust, group solidarityand leadershipwasespeciallylacking in Babil due topolitical andhistorical factors. Here, a single family was dominantin thevillage, and also provided the ürndah, or mayor; but as the family wasunpopularwith the villagers its memberscould not provide the necessaryleadership.Dunngfour yearsof action/researchthe researchcouldnot identifyor encourageinformal village leadersof the caliberneededto sustaintheinterventions.

Partof theproblemfacedin gettingcommunityactivities startedwasthat.althoughthe villagersrecogmzedacommonset of sanitaryandenvironmentalproblems,they could not see thai thesemight be solved They alsounderestimatedthe seriousnessof theseproblemsbecausethey did not linkthem with their own health or that of their children. The researchteamaddressedthis problemby discussingthe health implicationsof water andsanitationconditionsin aconcurrenthealth education program, as described inthefollowing chapter

Village committees. The conceptof a “committee” working on avolunteerbasisin the village setting wasnew in both studyvillages. A fewmembersmentionedthatif they were paid they might takethemeetingsmoreseriously:however,electedmembersof the Village Popular Council areexpectedto work withoutpay. The village committeeswere still in theirformative stages,having beenin operationonly six monthsby thetime theprojectended. Evenduring that time members,who had volunteeredor hadbeenspeciallyselectedbecauseof their leadershipqualitiesandconcernaboutsanitationissues,wereoften reluctantto follow up issueson their own andtaketheinitiative in solving them.Thecommitteeswhich wasconcernedwiththe high water table in Kair Shanawantook their responsibilitiesseriously,met regularlyand followed-upeffectively. Men took theleadingrole in this

4g

committee,as mostof the activities entailedworking with decision-makersatthe govemoratelevel, women did, however,voice their opinions duringcommitteemeetings. Wherea village committeefocuseson an activity whichonly involvesvillage level authorities,thereappearsto be no reasonwhy allor most committeemembersshould noi be women. All membersof thecommitteeto repairthe standpipewerewomen,andthey dealteffectivelywithother local neighborhoodresidentsandmembersof theVillage Council

A numberof importantfactorshavea direct bearingon the successofvillage committees,and should be considering when forming suchcommittees. Villages are complex settings. containing various hierarchicalsocioeconomicstructureswhich shouldbe analyzedand understoodbeforeinterventionsare started. Conditions in the two study villages were notidentical,for in Babil it appearedto be moredifficult for committeemembersto get their ideasacrossto decision-makerson the onehand,andto villagerson theother Internalvillage dynamicsalsoshouldbeexplored,sincedifferentresidential areas exhibit varying patterns of cohesion, organization andleadershippotential,andoverallpotentialfor groupparticipation.

Given the needfor formal administrativeapprovaland supervisionofcommitteessuchas thesein Egypt, it is necessaryto considerwho would beresponsiblefor thesecommitteeson the village level after the withdrawalofthe researchteam. Most villages have a Community DevelopmentAssociation,supportedby the Ministry of Social Affairs. Where this isstrong, as it is in Babil, it may be an appropriateumbrellaorganizationforvillage committees.

Administrative and management constraints. Any attempt toimprove village watersupplyandsanitaryconditions has to abide by the rulesof the administrativestructure:the legally establishedresponsibilitiesandprocedureshave to be followed at all times. After initial discussionswithvillagers, informal leadersand local Popular Council representatives,allproblems and proposed interventionswere discussedwith the VillageExecutiveCouncil andthe Village PopularCouncil. In bbth villages, at firstthe membersof the PopularCouncil did not interactwith the villagers, ormakemuch attemptto respondto or understandtheir needs. Similarly, theExecutiveCounciladheredto routinebureaucraticprocedures,anddid not takethe initiative in solving the problems.

Here,aselsewherein Egypt, administratorsat the village level, andevenat the mar/car level, were unable to take decisions unless approval by higherauthoritieswasguaranteed.Forexample,activities with regardto thepollutedcanal startedto take a more concreteshapeonly after the researchteamapproachedhigherauthoritiesand the governorformally requestedthat thevillage authoritiesconcernthemselveswith theproblem.

49

The time taken, and the ultiir alt success, of efforts to improve villagesanitary conditions depended ~w tie complexity of the administraliveorganization involved. The case o~tFe polluted canal and the problem of thehigh water table required a longe: ii ut to work through, and the administrativenegotiations were much more c3mpte~than for the routine repair andmaintenance of standpipes. In He latter case, no collaboration with anadministrative organization beyonc th~village level was required, and repairswere camed out quickly. This showed the results which could be achievedwhen opportunities are provid.~dfor villagers to act with village-levelauthorities on matters which affect both parties directly. However, even inthis case a favorable outcome depended on much careful work by the researchteam to open up the channels o~communication between the localadministration, the Executive Viflage Council and the elected PopularCouncil, and the villagers they were supposed to serve.

Many activities relating to the pclluied canal and the high ground watertable involved lengthy meetings at the markaz and govemorate levels in orderto obtain approval and cooperation for activities. The vanous ministnes anddirectorates found it difficult to coopeiate when considenng intersectoralvillage level needs,for each ministry operates primarily within in a separatehierarchical system. This process was especially complex in the case of thefeasibility study. The study coffid not be carried Out until the proposeddrainage/sewerage system had been integrated into the overall govemoratescheme for improving village infrastucture. This entailed frequent contactwith markaz and governorate authcrities responsible for irrigation, watersupply, and public health; agreement at the village level about prionties foroverall expenditure on sanitation rriproveinents; and adherence to deadlines forpresentation of proposals.

The problems of gaining approval for the feasibility study wereexacerbated by the fact that Kafr Shanawan was a satellite village, and it had towork out its priorities and needs within the context of those of the wholevillage unit, especially the adjacent main village of Shanawan. KafrShanawan had only two representatives on the Popular Council; proposalscould not be forwarded to the Executive Council unless these were first agreedon by the other members of the Popular Council. This suggests that theneeds of satellite villages and hamlets may sometimes be neglected at theexpense of those of the main village

The communication process. A complex government machinery,requinng a bureaucratic process at decision-making may soon discourage themost enthusiastic and persistent villagers. They viewed administrativeprocedures as tedious and often d~tdnot understand them. Both parties, villagersand administrators, needed to recognze the two-way communication processby which they could collectively work towards improving village sanitary

50

conditions. Here,the researchteamencouragedandguidedactivities,helpingto openandmaintmnchannelsof discourseanddialoguebetweenvillagers andmembersof theVillage Councilandotheradministrators.

51

CHAPTER FOUR

WATER AND SANITATION EDUCATION

PFO( RAMS

Introduction

Health education strategies. The health education programs werecomplementary to improvements in water and sanitation carried out in theother two study villages. Health education, if it is to be effective, must seek tochange or modify behavior, as well as knowledge and attitudes (Loevinsohn1990). Therefore it should incoi-pcrato a cultural perspective on humanbehavior. Researchers and planners should seek to understand how and whypeople behave as they do. They need 0 work with local people, to learn abouttheir health-related concepts, and to ideni ify appropriate healthful patterns ofbehavior which can be targeted by health education.

The health education project can-ax! out iii the two villages tested differentapproaches and techniques in heaith education, so that the research team couldrecommend the most effective strategies for the Egyptian setting. The projecthad two components. One reached village women, usmg a number of differentgroups of hygiene educators, and focusing on simple home hygiene messages.The second component was a summer club for primary school children, usinglocal teachers and incorporating activities centeredaround health education.

The health education process. The health education processfollowed in this study mvolves se ~enpnncipal activities:

i) Diagnosis: identification of health problems, health-related behaviorand its rationale in the local community;

ii) Formulation of aims, and scope of the projectiii) Identification of the target audience;iv) Design and pretesting of messages and methods of commumcation:v) Selection, training and monil oring of health promoters;vi) Intervention: health education to facilitate more healthfulbehavior;vii) Evaluation to ensure feedback and sustainability.Aparticipatory model of health education seeks to involve local people in

all stages of the process. This ensures that messages are relevant and that theyrecommend behavior which is feasible and favored by the local community(Simpson-Hebert 1984). A successful health education program also involvescollaboration between the representatives cf all relevant governmental agenciesat the village, markazand governorate level who act as planners, trainers,educators and monitors. The design o~the project, showing the integration of

52

the various stages,and the different strategiesemployed in testing aparticipatory,partnershipmodel is shown in Figure 6.

Healtheducationshouldbe anmteractiveprocessbetweeneducatorsandaudience,and, in our case, the researchteam (de Haes 1991). Theaction/researchmethod,whetherinvolving waterandsanitationinterventionsor healtheducation,is flexible enoughtorespondto newneeds,suchasthoserevealed during on-going monitoring and other interactions betweenresearchers,healthpromotersandlocal people.

Pre-intervention activities. Earlier rn-depth anthropologicalresearchin thestudyareahadidentifiedwomen’spracticesof womenrelatedto wateruseandsanitation,andhadsoughtto understandtherationalewomenhadforfollowing suchpractices(seeChapterII). Thisdiagnosisprovidedinformationaboutbehaviorwhich inhibits or facilitatesdiseasetransmission,andwhichcanbeusedin designinghealtheducationmessages.Thus, the aims,contentandscopeof thehealtheducation,the secondactivity in this healtheducationmodel,couldbeclearly identified.

A pre-interventionstudyof healthknowledge,attitudesand practicesamongformalandinformal village leadersandserviceworkerswascarriedoutto assesstheir health knowledgeand to identify their possibleroles in thehealth educationprocess. The study found that most of them would needspecific training to serveas hygieneeducators. Although92% of the 82peopleintervieweddid recognizea relationshipbetweenthe transmissionofdiseasesand flies or contactwith or useof contaminatedwater,few of themcould explain theselinkageswith anyprecision. Therewas little distinctionbetweenserviceworkers,formal andinformal leadersin their conceptualizationof the meaningof environmentalsanitation.For mostrespondentsthis meantanenvironmentfree from pollution andflies,and from solid wasteandsullagedisposalin thestreets,aswell aspersonalandgeneralhygiene.

The action/researchstrategystressedtheparticipationof local people,andthe useof village level facilities and staff to ensuresustainability. At theoutset, theresearchteamrecognizedthatwomeneducatorscould bestreachotherwomen,andcommunicatewith them meaningfullyin their own homes.The official job descnptionsof the various serviceworkers employedinhealth-relatedcapacitiesby the Village Councilindicatedwhich categoriesofworkersmight be potentialhealtheducators.Unfortunately,in the two studyvillagesmany of theseworkersandthe informal leadersidentifiedby the teamweremales The majontyof the service workerswerenot village residents.Thus,they would only be ableto deliver hygienemessagesduring workinghours, and would be unlikely to have the detailedknowledgeof localconditionswhichwould comefrom residencein thevillage.

53

FIGURE 6: DESIGN ~ THE HEALTH EDUCATION PROJECTTO TEST A MODEL FOR

INTEGRATED HEALTH EDUCATION

Working With And Targeting Village Womenand Primary School Chil dren

Anthropological Ritearch Guidingthe Contextualization of Health Messages

r Formulating Messages Stressing the Linkages Bebveen Behavioral PFkticitI Cycles of Disease Transmission and Environuental Sanitation

Nurses at Health Units

Village Outreach

Suimner Clubs

Neighborhood Based

The job descriptionsof sanitariansindicatedthat, although they wereresponsiblefor village level healtheducation,they would notbe ableto actashealthpromoters. All sanitananswere, by convention,male. They wereexpectedto perform regulatorytasksin thestreetsof the village,ratherthan inprivatehouses;they were responsiblefor fining peoplefor throwing garbagein the streetsand for inspectingfood vendors. Although samtarianswereresponsiblefor implementing vaccinationcampaigns,this tasktook placeinpublic settingsrather than in private domesticsettings(see administrativestructure,Figure 3). While women nursesat therural health units werenotpermittedto leave the healthunit during working hours,their job descriptiondid nothinder them from reachingoutto womenwho came to thehealthuniLPublic servicetrainees,young womengraduatescarryingout a yearof publicservicein their own communities,wereattachedto therural healthclinics,butunderthe authorityof the Ministry of Social Affairs. As therewasno rulingthat they could not leavethe healthunits, they were identified as possiblehygieneeducators.

Theschoolhealthvisitorswere notdeemedappropnateashealtheducatorsin the school settingbecause,although they supervisedthe school healthprograms,they had no direct classroominvolvement in health activities.However,theprimary school teacherswere consideredsuitableforconveyinghygiene educationmessagesto children in the school setting. A largeproportion,maleandfemale,lived in the two studyvillages andwererespectedlocalleaders. Becauseof theuseof differentgroupsof hygieneeducators,theresearchteamneededto collaboratewith stafffrom manydifferentministriesatboth the villageand,narkaz level.

Hygiene Education with Village Women

Introduction - testing hygiene education strategies.The healtheducationprograminvolving village women wasdesignedto comparetheeffectivenessof threedifferent groupsof womenhygienepromoterswho hadbeenidentifiedas suitableeducators- nurses,womenpeergroup educators,andpublic service trainees. Eachof thesegroupsusedthe samebasicmessagesbutadaptedthemaccordingto the settingin which they weredeliveredand theneedsof the targetaudience.

Theeducationprogramaimedto bring aboutsimplechangesin women’shabitswhich would resultin acleanerandmorehealthfulenvironment. It washopedthat thesechangeswould, in turn, leadto changesin child mortality andmorbidity, butthe identificationandmeasurementof suchchangeswasbeyondthescopeof thisproject.

The targetaudience. Youngerwomenbetween20 and 40 were themost importanttargetfor the healtheducationmessages,as they looked after

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young children.They usuallycaredouta largeproportion of the domestictasks;they werealsothe most likit ti usethecanalsfor washingclothesanddomesticutensils. The vast majaiity of the womenreachedwere illiterate,which meantthat educationhad Ic 1 basedon face-to-faceinteractionandsimple,well designedvisualmateiJ.

identifying and devehging health education messages.Specifichealth educationmessagesfccusedon water storage,infant feeding,handwashing,foodpreparation,litrine cleanliness,andthepreparationof dungcakesfor fuel. Overall, the p -ogram emphas~zedthe linkages betweenbehavior,cyclesof diseasetransmission,andenvironmentalsanitation;howandwhydiseasesaretransmittediii relation to thedaily practicesof thewomen(seeAppendix II for ñe English trar~slationof training materialand healthmessagesoriginally preparedin Aranic).

The messageswereshortandrelatedto women’severydayactivities. Thebasicmessagescouldbemodified to respondto local conditionsForexample,in Babil garbagedisposalwasstressedwhen the garbagecollectionsystemwasinstituted. During thesummer,themain seasonfor childhooddiarrheaand thetime whenpeoplecomplainedaboetflies, messagesaboutfood handlingandcovenng,diseasetransmission,andenvironmentalhygienewereemphasized.

Dunng training and outreach the health promotersneededsimple andrelevantreferenceandsupportmitenal. They wereprovidedwith magneticboardsandposterswhich they coaldtakefrom houseto houseor, in thecaseof the nurses,useat thehealthunit. Films were shown in the madayifa,thevillage meetinghousenext to themosquein Babil. Oneof thefinal activitiesof the health educationproject was the productionand publicationof 500copiesof a booklet in Arabic, with many colored illustrations: “Guide forTrainers: Health and the Enviroiiment’. The booklet was designed incollaborationwith theeducators,including theteachersin the summerclubs,andevaluatedby them. As shown in Figure 7, it wasdesignedin sucha wayasto relatedirectly to thevillagers daily experience.

The health promoters. Thirty four healthpromoterswere involved inthis project. Theywereexpectedto attendtraining meetings,carry outhealtheducationactivities on a fairly regularbasis,andparticipatein evaluations.Althoughthey were volunteers,thcy were given smallmonetaryincentivesforgoodperformance;thesewerenotmentionedduring recruitmentandtraining sothewomendid not work in anticipationof materialrewards. Threegroupsofhealthpromoterswere selectedfar tiarning; 8 nurses,12 village informalleaders,and 14 public servicetrainees

FIGURE 7

PAGE OF THE TRAINING GUIDE

Preparing dung cakes:- Carefully wash your hands with soap after preparing dung cake~- Immediately after finishing making dung cakes, change yourGalablya and put it in thesun to dry

- Wash the galabiya at least once a weekAvoid preparing dung cakes if you have a cut on your hand

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Village womenselectedfor heir leadershipqualitiesweretrainedas peergroupeducators;the majority were illiterate. At first the women visitedneighborhoodwomen in their o~vrhomes,but later they gave hygienemessageswheneverthey observedwumen following unhygienicbehavior--inthe markets,in the streets,and = i the fields. Nine womenin this groupwereresidentsof Kafr Shanawanwho workedon thesewingmachineassemblylinein a workshopin theadjacentvillageof Shanawan.Theresearchershopedthattheymight be ableto reachtheseventyotheryoung womenworking there,aswell astalking to womenin theirOWII neighborhoods.

The public service traineesreachedwomen in their own homes. Eachwomanworkedin thesamesmali densely-populatedneighborhoodthroughouther yearof service. In order to becomemore familiar with conditionsin thisneighborhood,and to identify particularenvironmentalproblemswhich mightrespondto healtheducationmessages,eachPSTcompleteda detailedcensusoftheneighborhoodin which shewas working. Later,eacheducatorselectedfivehouseholds,observinghygienebeh~viorin the householdsand conveyingappropriatehygienemessages

The nursesdeliveredthe health ne~sagesat the health unit where theyworked. Theycommumcatedwith womenwho werewaiting to seethedoctor,or waiting to havetheirchild immunized. Althoughmanycontactsweremadeduring small group discussions,nuisesoften held discussionswith largergroups,when they wereencouragedto usevisualaids.

Training. As prospectivehygiene promotersdid not constituteahomogeneousgroup,the variousgroupswere trainedseparately.All trainingwas done in small groups, of no more than ten people, in the settings inwhich thehealthmessageswereto bedelivered. Both training anddeliveryofhealthmessageswasvery informal, relying on group discussionsandvisualaids, andnever on lectures. The training wasdivided into two mainparts.The first partconsistedof training in groupdynamics,how to relateto peopleand to communicatea messageeffectively. The secondpart conveyedinformation about hygienic habits and their relationship to diseasetransmissioncycles,anddiseaseprevention. Theeducationprogrammcludedthe useof local terms,suchas ,mc,obe (plural,~n:crobat). This term is usedlocally in much the sameway as the term germis usedin populardialogueinEnglish(seeEarly 1988).

Initial training wasprovidedby consultantsbutgraduallymembersof theresearchteamtook overthetask. Somepublic servicetraineeswho trainedinthe first year volunteeredto remainin the programand train thenew PSTs.The headnurseat the healthunit conductedsomeof thetraining sessionsforthenurses.

Training of hygienepromoterscontinuedthroughoutthe project. Thisfollowedalearning-by-doingstrategywhich emphasizedproblemsolving and

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personalinvolvementin the projectwhich would havebeenimpossiblein aformal training setting. Membersof the researchteam met regularly withhygieneeducators,discussingwith them thecurrenthygieneproblemswhichmight be addressed,and how they might be introducedto the women.Thefollowing examplesof on-going training, supportandmonitonngare drawnfrom a reportof meetingbetweena researcherandpeergroup educatorsinJune,1988. Theresearcherstartedthe discussionby asking thewomenwhatwere themostpressingissuesthey neededto addressin their currenthealtheducationactivities. Fatmacommented:

Flies - we are doing ourbest to combatthembut in vain Wesprayinsecticidesall day, close the windowsand keepour housecleanHowever,oncewe openthe window theyenterthe house

The researcherthen explainedthat as long as peoplethrew wasteandgarbagein the streetstherewould beflies, regardlessof how cleanwomenkeptthe insideof their houses. A free ranging discussionfollowed about fliesspreadingdiarrheaand transmittingeyedisease,which wasreportedto be acommonailment amongchildrenbroughtto the healthunit

Amina wasconcernedaboutherroleas ahealtheducator.Shesaid:

It is sometimesvery difficult to deal with people Theymakefun ofus and do not listen Theystartedjoking aboutmeandup till nowtheycall me“that womanwhowantsto teachushowto be clean”

To which Fatmaresponded:

Weshouldnot dealwith womenin sucha way that gives themtheimpressionthatwe are better and want to teachthem All that wesayhasto beput mildly, impersonally,andin an indirect way

The practice of health education. The flavor of the educationalopportunities,onecanhardly think of them as formal sessions,held by peereducatorsis caughtin therecordsof their oral reportsto the researchers.InJanuary1988,Amina talked to four relativesof her husbandwho live in thefields alongsidea canal. She told themnot to drink canalwater,to which theyreplied: “Our parentsand grandparentshaveusedcanalwater and nothinghappenedto them.” Amina then discussedwith them the pollution of thecanal,and its relation to diseases,andher listenersacceptedthis, addingtheproviso that teamust be madewith canal water. Amina’s answerwas: “Thiswill not be harmful, sincethe wateris boiled and this kills the microbat.” Itis a well known practicethroughoutthedelta to maketea(andto cook beans,

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fuul) with canalwater; the piped system,which drawson subsurfacewater,hasa highmanganeseandiron c)rtel I ‘~hichaffectsthe tasteof the tea.

Zeinabreportedon her attempt~to persuadea womanwho wasmakingdung cakesfor fuel to changelicr dresswhenshe finished. Zeinab’ssistercommentedthat she shouldnot e:~pe:tlocal peopleto changetheir behavior:“They keepon wearingthesamei~a(4~bi)’a.Whenthey seeit is dirty they turnit insideoutandput it on again.

Home visits, anddiscussicnswhile women were washingat the canalprovidedplenty of opportunity ~odncusa wide rangeof hygienepractices,butalternativemeetingplaceswerealso considered.Theresearchteamandthehealtheducatorsidentifiedcommunalmud brick ovensasplaceswjierewomenget together. The womentakethe doughfrom their own housesto thefurn,shapethe flat loavesandpull thcn in andoutof the ovenon long paddles.atthesametimefeedingthe fire w th corn stalksanddungcakes. It did not takethe hygienepromoterslong tore:mlize that the womenat theovenswerefar toopreoccupiedto pay any attentionto their messagesabout covenngthe new-bakedbreadandnot handlingthedung cakes.

In somecases,a numberof women and girls who were not serving ashealth promotersspreadhealth messagesin the community. In Babil. forexample,onebeneficiaryof hygieneeducationtook on the responsibilityofconveyingto otherwomeninfonnatiori she had learnedaboutusing a thickcurtain to separatethezariba, animal shed,from therestof thehouse. In KafrShanawan,oneof the olderhygienepromotersrecruiteda youngerwomantohelp herineducatingotherwomenin anareafar from herown residence.

Evaluations. Ongoingand final evaluationsusedboth quantitativeandqualitative surveymethods. On-gowgevaluationsof healthpromoterswerebased on formal interviews, oral reports given at meetings, and onobservationsof educationalactivities. Focusgroupdiscussionsandinterviewsassessedthe knowledgegainedby membersof the different groupsof healthpromoters, their assessmentof personalbenefits gained, and problemsencountered.The evaluationat the impact of the health educationonbeneficiariesfocusedon bothknowledgeandbehavior,in order to find outwhat the villagers had learnedand i’~this knowledgeresultedin changesinbehavior. Regularmonthly evaluationsby public service traineescovered25% of thewomenreachedby theeducalors.Thefinal evaluationwasevenlydivided betweena control group of wonienwho werenot exposedto healtheducationmessages,andanexpenmentalgroup exposedto themessages;theywerealso evenlymatchedaccordingIa housingcharacteristics.89% of thewomen were illiterate and90% were between20 and40 yearsold. Formalinterviewsrecordedthe women’sknowledgeandreportedbehavior Womenevaluatorsfrom anothervillage, who did not know what health messageshadbeenused,weregivena guide list of behaviorstoobserve.Thesewere related

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to the health educationmessagesconveyedto the women by all healthpromotersin a varietyof settings.

Results - comparative performance of health promoters.Nurses:Nursesat thehealthunits were the mostsuccessfulgroup of healtheducatorsin termsof conveyinginformationandpersuadingwomen tochangetheir behavior. Eighty percent of the women receiving information fromnursesat thehealth units reportedthat they changedbehavior,comparedto58% of all womenreceiving health education.Twenty-eightof 31 womenevaluatedreportedbenefitingfrom thenurses’educationaboutdiarrheaandeyediseases.

Motherswaiting at the healthunit to seethe doctoror havetheirchildrenvaccinatedpresentedopportunitiesfor informal healtheducation.Forexample.if a woman broughta child with diarrhea,thenursecouldbegin a discussionaboutthe causesof diarrhea,asking the women what they knew about thedisease,andsuggestingsimplepreventivestrategiessuchascovenngfoodandwater,washingvegetablesandhands.Messageswereeffectivebecausewomenlistenedto the nurseswith respect,yet felt closeenoughto talk to them abouttheir intimateconcerns.

Public servicetrainees: Thepublic servicetraineeswereeffective inapproachingilliterate village women. Of 31 womenevaluated,23 saidtheyhadadoptedmostof the measuressuggestedby the public servicetraineesontheir home visits - such as covenngwater and food: cleaningthe foodpreparationarea;and making a door to separatethe cattle shed from thecooking area. Women hadgood reasonsfor not following some of theiradvice.They complainedof having no time to clean the houseafter beingoutall day,of overcrowding(13 peoplein two rooms),andusingcanalwater asthey hadno time to wait for waterat thepublic standpipe.These commentsillustrate the hiddencostof behavioralchangepromotedby healtheducation.Women know that their practicesare nothealthy,but they may havelimitedfreedomto makehealthfulchoices.

Peer educators: Peereducatorsrelatedwell to the womenthey visitedin their own homes,andthewomenrememberedthe messagesIn general,theolder women weremore successfulas peereducators,as youngerwomenlistened to them and respectedtheir experience. Even though the youngwomen recruitedfrom the sewingworkshopin Shanawanworkedregularlyoutsidetheir own homes,only five of the nine womeninitially recruitedfromthe workshopcompleted the training and beganto move around theirneighborhoods.Oneunmarriedyoung womanwastoo simy to talk to peoplearoundher aboutthepracticesandbehaviortheyoughtto change:shewas theyoungestsibling in thefamily andwasnot accustomedto having any say in

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householdmatters.Two young A’ornen with small children were forbiddentoparticipateby theirparentsin-la’ ~‘. TI e mother-in-lawof oneof them said thatit wasbetterfor herto stay at l irme md look after her own childrenthan “towasteher time talking about ti iv ma with other women”. The conventionalevaluationprocessdid not captu-eall of the activitiesof peergroupeducators,or the long term impact on vill2 g~iv omenof their trainingandparticipationin theprogram.

Comparedtoothereducatom,the utilizationof peereducatorswasnotcosteffective. Trainingandevaluati:)nwas lime consuming.Becausethe womenwere illiterate, most training was done on the job, and the trainershad todevisea simplemethodfor the womento makeoral reportsof their activities.Women wereevaluatedindividially in the householdsetting. The drop-outratefor the peereducatorswas alsoh~ghcrthanthe for theothergroups,partlybecausethe womenwereuncertainrbout their role, which wasnotrelatedtoany of their existingdomesticor economictasks,and youngerwomen weresubjectto theauthontyof their parenisor in-laws.

Illiteratevillage womenhadrclativety hadfew opportunitiesto meetotherwomen outsidetheir own homesot those of close relatives.Nor did thesewomenhavea traditionof collective iction which would haveenabledthemtomeettogetherinformally to shareknowledgeanddiscusscommonproblems.

General benefits to health promoters. Some of the materialpresentedto the healthpromoieswas new, and it took time for them tointernalize it, and to practice it I hemselves,before they were able tocommunicateit effectively to othervillagers. The researchteam noted achangein the hygienebehaviorof tie healthpromoters,and their increasedawarenessof their surroundings,as a resultof their training andparticipationin the program. Suchchanges,on rhe part of leading village residents,arelikely to havesome long-term impact on environmentalconditionsin thevillage.

Results - beneficiaries. The interviews indicatedthat, overall, thegroupexposedto healtheducationicle:ilified healthfulbehaviormoreoftenthanthecontrol group. The greatestdifferencebetweenthetwo groupswas in theareaof hygienicwater storagepractices. There was a differencebetweenknowledgeand behaviorin both groups, but knowledgewas not alwaystranslatedinto practice. For example,as shown in table2, in Babil, 100% ofthosein the experimentalgroup and 86% of thosein the control group saidthat water containersshouldbe covered;however,48% of the expenmentalhouseholds visited had covered stored water, compared to only 19% in thecontrol group.

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TABLE 2REPORTEDWATER STORAGE PRACTICES

Response Babilexpenm. control

Freq %Freq %

Kafr Shanawanexpenm. control

Freq %Freq %

Coveringwaterstoragecontainer 42 100 36 86 37 100 36 97

Cleanplace 27 64 16 38 12 32 9 24Washcontainer

regularly 12 29 14 33 17 46 12 32Cleanhandsbefore

drawingwater 13 31 — — 5 15 5 13Regularlychange

water 9 21 6 14 4 11 2 5Cleancupfor

drawingwater 14 33 1 2 4 11 1 3Protectwater

from flies 6 14 1 2 5 13 0 0Neverreturnleft-

overwaterafterdrinking 1 2 0 0 0 0 0 0

Sample 42 42 37 37

Interviewsn = 158Respondentsgavemultiple answers

Messagesemphasizedthe importanceof hand washing with soap,inrelation to householdchoresandchild care. Both observationsandinterviewschedulespointed to differencesin resultsbetweencontrol andexperimentalgroups. Mothersin the experimentalgroup wereobservedto instruct theirchildrento washtheir handsafter defecation(19% in Babil and27% in KafrShanawan),while in the control groups this was not observedat all. Asshown in Table3.

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FAILE 3REPORTED HAND ~VASHING PRACTICES

Responseexpe

Req

Babrim,

%

iicontrol

Req %

Kaexpe

Req

fr Sharim,

%

nawancontrol

Freq %

Befc~eeating 40 95 40 95 35 95 36 97preparingfood 37 88 34 81 32 86 31 84feedinginfants 11 26 3 7 7 19 7 19

Aftereating 34 81 39 93 34 92 31 84housework 38 90 24 57 30 81 25 67defecating 21 50 6 14 0 0 0 0sleeping 1 2 0 0 0 0 0

Sample 42 42 37 37

Interviewsn=158Respondentsgavemultiple answers

26% of the experimentalgroup and 7% of the controlgroup in Babil saidthathands should be washedbefore feeding infants; however,33% of theexperimentalgroupbut only 5% of the control group wereobservedto do so.As onewomansaid:

Before!usedtofeedthe baby whenever shecried, evenif my handswerenotclean Now! canleave tizydaughtercryingfor a while until! washmyhands.

Overall,theevaluationindicatedthat womenexposedto healtheducationpracticedmorehealthfulbehaviorthan thosewho hadnot receivedit. Theresultsof theobservationsaremoreimportantthaninterviewsbecausewe needto know what peopledo, not what they say they do. If health educationchangesknowledge,but not practices, it cannotbe said to be successful(Loevinsohn1990)

Young unmarriedwomenwho were responsiblefor domestictasks,anddid not haveolder siblingswho would object to what they did wereable toimplementnewpractices. However,otherscouldnotdo sobecausetheywereseenas too young, they hadonly partial responsibilityfor certainimportanthouseholdtasksor they facedpressurefrom their in-laws.

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Concluding comments. The institutionalization of the healtheducationprogramsaimed at women showedthat nurseswere the mosteffectivegroupof healtheducators.Theeffectivenessof nurses,operatinginthehealthunits, is noteworthyasthe nurse/clinicsettingis replicatedm mostdevelopingcountries.The public clinic, providing basicpnmaryhealthcaresuchas immunization,diarrhealdiseasecontrol,andfamily planning,is oftenthe first contactof themothersandtheirchildrenwith the formal healthsector.Sucha settingprovidesnaturalopportunitiesto initiatehygieneeducation,andalso helps to overcomewomen’sreluctanceto use the primary health carefacility for bothpreventiveandcurativecare.

The public service trainees were also effective in communicatingappropriatehealthmessagesin domesticsettings. Although theywereyoung,as graduatesthey were respectedby local womenand had more freedom tomove about thevillage than did the peereducators.However, their time ofservicewas limited to one year; the following year a new grouphad to betrainedandsupervised- oftenthey were gainingin confidencejust astheir termof servicewascoming to anend. Four of the participantsin thefirst year ofthe program,who continuedto live in the village, volunteeredto continuetheir involvementin the program. They did this on a voluntary basis,eventhoughtheydid nothaveregularjobs. As oneyoung womansaid:

Wecannotsit idle as before Now we are usedto utilizing our timein a constructivewayand it wouldbe difficult to remainat home

These were the girls who, during the second year of the program, trainedincomingPSTsandearnedout evaluationsof the summerclub programandofthewomenrecipientsof healtheducation.

Theformalevaluationsshowedthat,althoughsomewomenwereeffectivehealth educators,the use of illiterate peereducatorsencounteredproblemswhich limit the replicability of this part of the health education program.Overall, this groupwas the leastcosteffective,in termsof longer timeneededfor individual training andmonitoring,and the high dropoutrate. However,anecdotalevidencesuggeststhat peer educatorsgainedconsiderableandsustainedpersonalbenefitsfrom participatingin theprogram,and that theyoften continuedprovidinginformation to theirpeersafter the formal programcameto anend.

Thishealtheducationexpenenceshowedthat a programdirectedtowardswomenmustalsoinvolve themen,whoseapprovalandsupportis requiredforwomento participateashygieneeducators.On severaloccasions,thevillagewomen suggestedthat a male memberof the researchteam discusstheprogramwith themen,so that they would allow their wivesanddaughterstoparticipate. Thisstrategywas successful.

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Summer Clubs

Aims and objectives of the ~ui’imer club program. The schoolhealtheducationprogram,taking pIceduring thelong summervacation,wasan additional health education sira egy which could be tested for itseffectivenessin the village setting it v ~asyet anotherway to reachthe villageaudience--primaryschool childrer-- with environmentalhealthmessages,at aspecialvenue,and with anothergroup of local people--teachers--actingashealtheducators.

The mainobjectiveof the programwasto providechildren with basicknowledgeabouthealthandhygienepracticesrelevantto real-life situations,which would result in a changein their behavior. The program alsoencouragedchildren to developself-relianceand the opportunity to assumegreaterresponsibihtiesfor their own health. The programhad the wider aimof helpingchildrento communicatehealth-relatedbehaviorto their family andpeers,and to encouragetheir involvementin community-basedefforts toimprove sanitaryandhealthcondmtions. The programalsoaimed to increasethe knowledgeand skills of the teachers. Thus, the program aims werecongruentwith those of the overall action/researchproject to developandsustaincommunityhealthandwelfare.

The setting. Education is free andcompulsoryin Egyptuntil age14,and90%of eligible childrenarerecordedisattendingprimary school;98% ofboys and 83% of girls (CAPMAS/UNICEF 1989,p 100, 106). However,health educationplays a minor role in the schoolcurriculum. Becauseofcrowdingand thepracticeof runningdoubleshiftseveniii manyruralschoolsthere are limited opportunitiesfor extracurricularactivities which mightincludehealtheducation.

Summerclubs,primarily recreaticnalin orientation,are alreadyoperatingin someEgyptianschools,and the local administrationin the studyareahadsometimesprovidedfundsfor teachersandequipment.Thus theresearchteamdecidedto supportsummerschoolsas an ideal opportunity for introducingadministrators,teachersandstudentsto currentapproachesto healtheducation;teachinglife skills and linking what :s learnedin schoolwith out of schoolactivities and behaviors(WHO/UNESCO/UNICEF1992). Theaims of thesummerclubsarein line with recentgovernmentalpolicy to encourageyouthsarid children,andtheir teachers,to Lake an activerole in improving localsurroundings.Thiswasoneof thefirst experimentsin thegovemoratewhereeffortsat the village level were directedtowardsencouragingtheparticipationof childrenin thepromotionof enviroiimentalsanitaryconditions.

From the beginning the iesearchteam worked closely with theadministrativeand teachingstaff im the selectedschools;full approvalandcooperation wasalsoneededat th~sstagefrom theMinistry of Educationat the

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markaz level. To encouragethereplicationof this experimentalprogram,policy-makersfrom the Ministry of Educationat themarkaz andgovemoratelevel were later involved in training teachers,and in supervisingandplanningtheprogram.

Teachersas health educators.Teachersare recognizedas ideal healtheducatorsbecausethey areauthority figures to whom childrenwill listen withrespect. In the schoolsetting,they areoperatingin a role that is comfortableand familiar for them,and for the childrenthey are reachingout to. In pre-interventioninterviewsin the villages,87% of primary schoolchildrensaidthat theyhadgainedmostof theirknowledgeabouthealthfrom (heirteachers,ratherthan from their family or theirpeers,or from the school healthvisitor,whose role is supervisoryratherthan educational. In Egypt. where manyprimary school teachersare localpeoplewith closetiesto thecommunity,theteachersare well known to children and their parentsoutside the schoolsetting,andarerespectedascommunityleaders.Overhalf of the teacherswhovolunteeredfor thesummerclubs lived m thevillages in which they taught.

A pre-traininginterviewschedulewasadministeredto teachersresponsiblefor teachingthe health and hygiene modulesin the curriculum. Theseinterviewsweredesignedto identify possiblesummerclub teachers,as well asto obtain information on their role in the schooland their healthknowledge.Forty percentof the 53 teachersinterviewedclaimedthat disposalof solidwasteandsullagein the streetswas themain problemin the two villages,and30% mentionedthe lack of a seweragesystem. However,onequarterof theteacherssaid that the solution lay with thegovernment. Theresultsof theseinterviews, and those with 230 children, in which they identified similarenvironmentalproblems,helpedto identify the themeandcontent for thesummerclub programs.

Thesummerclubsprovidedan opportunityfor teachersto realizetheir fullpotentialand improve their teachingskills. Most of the teachers’knowledgeof healthwas theoretical,and the regularschool curriculum provided fewopportunitiesfor them to apply this knowledgeto the daily life of theirpupils. Thus, thechallengeof the summerclubs wasto train teachersand toprovide themwith informationandmaterialswhich capturedtheirown interestandwasdirectly relevantto thehealthneedsof the children. Themorerelaxedandinformal atmosphereof thesummerclubs,comparedto theregularschoolsetting,facilitatedeffectiveteacher-studentinteraction.

Children as an audience for health education. The primaryschoolchildrenattendingthesummerclubs overthe threeyearperiodwereallfifth andsixth graders,betweenthe agesof ten and twelve. This is thefinalyear of primary school in Egypt, andmay be the lastuninterruptedyear ofschoolingfor somechildren,eventhoughtheofficial school leavingageis 14.

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Althoughsomechildrenwork in the fi Ids during the summervacation,thereare few educationalor recreationalOPI oilunities availablein the village; theboysplay in the dustystreetsant alkys or go swimming or fishing in thecanals,while thegirls help their matbe s in the house.

Many studieshaveshowntha.hoti girls andboys in this agegroupplaya key role in promotinggoodhealti betavi or in theirfamiliesandamongtheirpeergroups. They learnquickly, they are enthusiasticandanxiousto applytheir knowledgein theirdaily life. In the studyvillages,aselsewherein ruralEgypt, girls at this agearealreadyheIp~ngtheirmothersin domestictasksandlooking afteryoungersiblings. Thus,hey caneasily appreciatetherelevanceof messagesaboutpersonaland homehygieneandput them into practiceintheir daily lives, and they are often able to communicatethesemessagestotheir mothers.As futurecitizensand parents,healthfulbehavioradoptedbychildrenwill havelife-long benefits(seeWHO/UNESCO/UNICEF1992). Sofar, this group hasbeenbypassedin mostefforts to improve healthandruralwelfarein Egypt

Designing the program and training the teachers. The theme“Health and theEnvironment”waschosenfor the first year summerclubs.The following topics were discussed:personalhygiene: home hygieneincludingnutrition andhygienic food handling:andenvironmentalsanitation.During the secondand third yearsmore emphasiswasgivento themethodsofdiseasetransmissionand to behaviorwhich would prevent the spreadofdisease,especiallyschistosomiasis.

Two male and two female teacherswere initially recruitedfrom eachschool. The teacherswere trained immediately before the summerclubsessionsin small informal groups,using face-to-facediscussionsratherthan alectureformat. The training wasdivided into threecomponents;basichealthinformation that neededto be communicatedto the children; methodsofcommunicatinginformation to the children; and simplecrafts using localmaterials.

As with the training of womenhygienepromoters, the initial trainingwas carnedout by a consultant,while later training wasconductedby theresearchteam. However,it shouldbeemphasizedthat, especiallyduring thefirst two years,theactualimplementationof the summerclub was in effectanon-the-jobtraining for theteachersinvolved. Thiswasfeasiblebecausetheresearchteam guidedtheactivity andpracticedwith the teachersthe differentstrategiesfor reachingthechildren.

From the beginning,training programsandevaluation involved inter-sectoralcollaboration,as staff outsidethe Ministry of Educationwereused.The director of the nursesat the governoratelevel administeredthe healthcomponentof the teachertraining. Publicservicetraineesattendedthe teachertraining sessionsandwere then trainedto monitor the summerclub program

53

andkeeprecords. The researchersmetbiweekly with the teachersand thepublic servicetraineesto evaluateactivities,modify theprogramor dealwithany problemswhich emerged.

A brief teachingguide waspreparedfor the teachers’ use, and a simplepamphlet for the children covered the main topics in the program. Theillustrated booklet: ‘Guide for Trainers: Health and the Environment”, whichwas prepared for all trainers in the health education program, was ready for useby teachers in the final summer club. In the final evaluation, the teachersreported that it was very helpful, and they wished it had beçn available earlier.

Setting up the program. Two pnmary schools,one in each studyvillage, were selected as the locations for summer clubs during the first year,1988. In Babil, the summer club was attended by approximately 100 girls andboys from the three pnmary schools in the village. Five teachers from theseschools, and the headmaster of the school in which the summer club was held,were involved. In Kafr Shanawan, about eighty children from the two pnmaryschools attended the summer club, supervised by four teachers and theheadmaster.

The clubs operated three times a week over a six week penod. Every daythere was a three hour session, dividedby a half-hour break. The children weredivided into groups of between 25 and 30. In the morning the groupsdiscussed a specific health topic, through the medium of group discussions,making posters and story-telling. In the afternoon, the groups followedactivities reflecting their interests and those of the teachers. Groups includedacting, home economics, art, crafts and music.

Groups of children were taken on walks around the village to observepractices which might be harmful to health, or which would be beneficial.Children and teachers cleaned the school and its surroundings, and workedtowards improving the condition of the school latrines. These activitiesculminated in the children’s participation in a cleanliness campaign in somevillage neighborhoods, when the children collected garbage and swept thestreets.

The teachers in each school organized a final party for the children whichalso provided them with an opportunity to share the results of their activitieswith their parents and other children. The art group showed the waste basketsand posters they had made; and the acting group presented some short songson health, and acted a short play emphasizing the importance of adoptinghygienic practices.

Results - the beneficiaries. The first year summer clubs, held in1988 in two schools, were attended by a 180 children and involved 11 teachers.By the end of the third year, the program had reached over 1,000 children in sixvillages. At the end of the first year, a detailed evaluation of the beneficianes

69

of thesummerclubscoveredbOth C ~ii.ren andtheir families. In general,thisshowedthat all the interviewees,cii dim andparents,wereverysupportiveofthe summerclubs. Parents,espei;113 mothers,werevery impressedby thenew habits children had leamei, w itch included regular hand washingcombingof hair, andwearingcleait rio lies. Onemothersaid:

My sonwasso attachedto :~esi miner club that! did not have towake him eachmorningand spenian hourtrying to get him out ofbed He wokeearlyand wastedhmselfto go to the schoolclub

Anothermotherreporteth

My daughterbecamevery meticudour aboutwashingvegetablesandspecifyinga separateglassjor ~ri~ikingwaterfor everyonein thefamily Sheeven wantedto washthe eggplantswith soapbeforecooking them Shealwaysreils me that we have to wash lettuceleavesoneby oneunderrunn~Pi~H ater in orderto kill the microbat.

Many of the children acqtiired new information, especiallyaboutschistosomiasisinfection, flies a~diseasetransmitters,andothersourcesofpollution and their effects on health. Someof thechildrenadoptedhygienicpracticessuchasregularlywashingther handsbeforeandaftereating;washingvegetablesand covering food; refr.inrng from swimming in the canal;sweepingin front of thehouse:ard thi owing garbageinto coveredcontainers.Somechildrensharedtheir newinformation with peersandsiblings. One ten-yearold boy said:

Everytime I seemy youngerbrother walking barefoot,[insist thathe wearsshoes,otherwiseI refuseto walk with him Also, whenIsawhim playing in thestreetand theizpickinga tomatoto eat.I tookit fromhim andwashedit lie is still tooyoungto know that eatingvegetableswithout washingthemcanleadtodiseases

The sustainabiityof suchbelavior is important,but less easyto measurewithin the time frame of the reseirchOrolect. Membersof the researehteamwalking throughthe village m the latefall, threemonthsafter the endof thesecondsummerclub, met childrei who were still following thepracticestheyhadlearned;they werehelpingto cleaethe surroundsof the public standpipe,collectinggarbageandthrowing ii into thedonkeycartwhich collectedgarbagein Babil village,andwerecleaningin front of their homes.

Children who had attendedthe ummerclubs also becameinvolved inotheractivities. In Babil, after theproj~rarnhadbeenestablishedfor two years,a group of five girls approachedthe i esearchteama numberof timesto ask

70

about the garbagecollection cart that hadbeenoperatingthere. When thiswastecollection systemhaltedfor a while, they went to the village councilrepresentativeto seewhathadhappened.This groupalsoundertookto cleanarounda public standpipewhich washeavily usedby local women.Since theywere now in preparatoryschools and had outgrown the agelimit forparticipatingin the summerclubs, they had collecteda groupof youngervillagechildren,especiallyschooldrop-outs,taughtthem to readandwriteandtalkedto them abouthealthanddisease.Childrenalso pressedtheirparentstoparticipatein the otheractivities of theaction/researchproject. Forexample,oneof the girls m Kafr Shanawanwhosemotherhadjust given birth to a newbabykept on remindingher to attenda village committeemeetingto discusstheproblemof the high groundwatertable.

Results - teachers.For the first year summerclubs,in two schools,eleven teacherswere trained. At the endof the first year’s summerclub,interview scheduleswere administeredtoassesschangesin theteachers’healthinformation. Only threeof the eleventeacherssaid that the training did notprovide them with new information, while the remainderclaimed that thetrainingwidenedtheirhonzonsandsuggestedvariouswaysof communicatingcommunity healthconcernsto children. All the intervieweesknew that fliesweremajortransmittersof disease.andall couldexplainhow exposureto canalwatercanleadto schistosomiasis.

The teacherswerealsoaskedto evaluatethesummerclub experimentbycommentingfreely on a numberof themes. Almost all the teachersaffirmedthat the summerclubs were successfulin reachingthe studentsandprovidingthem with healthinformation in an interestingway; for the first time childrenwereofferedthechanceto practiceandimplementthe theoreticalconceptstheylearnedat school. The applicationof healthinformation wasnotconfinedtothe immediateschoolenvironment. The teacherswho lived in the villagesobservedchildrenadoptingmanyof the hygienic practicesthey had learnedatthe summerclub and encouragingothers to do likewise. Almost all theteachersagreedthat they hadgainednew skills in communicatinginformationto childrenwhich wasrelevantto their daily life, andusinglocally availablematenals.

Extension of the program. After the first year summerclubs, theprogram was continued in the two villages with a new theme: HealthEducation: the Pillar of PreventiveHealth Care. Twelve sessionswerescheduledandnewmaterialintroducedon how diseasesare transmittedand howtheseare relatedto the children’sbehavior. A similarpatternof daily activitieswasdesigned,with practical groupsmeetingin the afternoon. During thosesessions,some childrenpreparedwire net food covers,andmadecoversforqulla-s, watercontainers.

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In the two schools,about 16C c iillreii took part, underthesupervisionoften teachersandtwo headmasters.F- o~‘ever, attendancelevelswerelower thanthe yearbeforebecausecotton, the in in cashcrop, washeavily infestedwithcotton worms andchildrenweren~de1for the tediousjob of picking them offthecotton plants, oneby one, thrcugioutthe long, hot summerdays. Theevaluationconductedat the endo’ trio summerclub sessionshowedthat,asinthe weviousyear,thechildrenrn:)st rcadily adoptedpracticesrelatedto theirpersonalhygiene,suchas handwashing,and to their householdchores,suchas coveringfood andwater containers.

Building on the activities of the first year’s summerclubs,the researchteamalso decidedto encourageextra-curricularhealthactivities in oneof theparticipatingschools. Dunng the school year 1988,~,the teamencouragedtheHealth Activity Group to disseminatehealth information first among itsstudentmembers,and then among the otherschool children. The researchteam suggestedtopics for the monthly meetingsandprovidedaudio-visualmaterials. However,the groupwris not readyto assumetheseresponsibilities,and the teacherwho supervisedthe group activitiesneededmore training. Thefinal examinationperiod, in Apil, an~the fasting monthof Ramadansloweddown all extra-cumcularschoolactivities.

During the third year, 1990, summer schoolswere conductedin sixvillages,reachingapproximately100 childrenin eachvillage. The summerclubs wereextendedbeyondtheoriginal two studyvillagesin orderto find outwhetherthe programcouldbe replicatedand sustainedonce theresearchteamhad withdrawn its support,and what problemsmight be encounteredin sodoing.

Constraints.Evaluations showedthat, over the threeyear period, manyteachersandstudenLshadbenefittedfrom the summerclubs. However,it tooktime for teachersto becomeaccdstomedto new teachingmethods,whichstressedtherelationshipbetweenthematerialpresentedandeverydaylife ratherthan beingsimply theoreticalor hasecon rote learning. Teachersalsolackedthe experienceof working togetherandsharingtheir findings. Theyfrequentlyblamedtheir lack of innovationon a shortageof materialsfor classroomuse.althoughsometeachersdemonstratedthat thesedifficulties couldbeovercome.

Replicability and sustainability. Collaboration with the Ministryof Education and otherministries at the village and markaz level, whilefacilitating thesmoothrunning of :he pioject,wasalsointendedto ensureiissustainability. During the first two ycars,the scopeof Ministry of Educationinvolvementin the two ,narakaz graduallyexpanded,asthey helpedto selectthe schools,designand conduct the training of teachersand monitor thesummerclub activities.

72

In the third year, 1990, theEducationDepartmentundertookto supervisetheoverallprogramfor all six villagesin th~two ,narakaz,to encouragethemto take over the futureoperationof the summerclubs. They madeperiodicvisits to eachof the six schools,which also encouragedthe seriousnessandcommitmentof theparticipatingteachers. In consonancewith their rolein theaction/researchproject,the researchteamactedasa catalystin coordinatingtheactivitiesof theEducationDepartmentandtheschooladministrationstaff, andmonitoredthe program. They alsoprovidedextrain-servicetrainmg for theteachersandmatenals,suchasvisualaidsfor classroomuse.

Since the beginning of the project, cooperationwith the Ministry ofSocialAffairs hadenabledpublic servicetraineesattachedto the healthunitstohelp to monitor the program. If the program is to be institutionalized,extendedbeyondthesesix villages in Menoufia governorate,collaborationbetweentheMinistry of Education,theMinistry of Healthand theMinistry ofSocial Affairs at the rnarkaz andgovernoratelevelswill beessential.

Lessons Learned

Many messages,many settings. The study showed that, in the villagesetting, a diversified groupof hygienepromoters,whetherserviceworkers,peereducators,public servicetrainees,or teachers,canreachdifferent segmentsof the village community. The impact of health messagesis multipliedbecausethey comefrom so many varied sources. In addition, they are allrelatedto thecentralenvironmentaltheme,andfocus on everydayactivities.

Theseconclusionsarenotunexpected.Theyreflect thosefound in currentstudiesof participatory health educationprogramsin other developingcountries. After a reviewof overeighty journal articleson healtheducation,Loevinsohn(1990) concludedthat healtheducationwas more likely to besuccessfulif: i) therewereonly a smallnumberof messages;2) they areofprovenbenefitto thecommunity; 3) they arerepeatedfrequently;and4) theyaretransmittedin manydifferentformats.

Local leadership and empowerment in the village setting.As with the water andsanitationinterventions,the healtheducationprojectneedsto be understoodin the local contextof village mores,power andleadership. Women, especiallyyoungerwomen, in many casesneedtheconsent of their fathers, in-laws or husbandsbefore becoming healthpromoters Thus,evenin a healtheducationprogramdirectedat women,andinvolving activitieswithin thedomesticsphere,the supportandcollaborationof men,asinformal leaders,husbandsandfathers,shouldbesought.

Local conditions meed to be considered in assessing leadership potential.Therecruitmentof village womenas hygienepromoterswas moredifficult inonevillage becauseof the moreatomisticstructureof the village, whereasin

73

theother village,oncea few proroer~hadbeenidentified, they wereabletouse village networksto help the re~eirci learnidentify newrecruits.

Health educatorsaremostef eoti’ e if they areacting in roleswhich arefamiliar to them and to their audit noe.Thus,in thevillage setting,nursescancommunicateeffectively with wormn tteridinga healthclinic, andteachersatthe summerclubs communicatesiccesslullywith primary school children.The womenpeereducators,in contrast,werenot accustomedto conveyinghygienemessagesto womenin theirown homes.

Therelative lackof successof womenpeereducatorsalsoappearsto berelatedto the fact that villagers,especiallywomen,are not yet used to theconceptof serving their communties, andworking voluntarily. It takestimefor the ideaof voluntary participationto becomeacceptedand for a groupofpeoplesuchashygienepromotersto becomeactiveandhappywith their newrole. However,thosewomen who hrve embracedtheconceptof voluntaryactivity and haveacted accordiigly are becominggood spokespeopleforenvironmentaleducationin thevi lage.

An educationprogramcanempowerwomen,asthey acquireknowledgeand with it, some control over their own health and the health of theirchildren. Participationin theprogramcan empowerthe educators,whethertheyareilliterate village women,nurses,public servicetraineesor teachers,bygiving them basichygieneknowledge,confidenceto presenttheir ideas,theability to work togetherandsharetheir expenences,andaddedrespectin thecommunity.

Resourceneeds. The health educationprogram demonstratedtheimportanceof starting with what is available locally, even though theresourcesappeartobelimited. Theprojectusedlocal staff, expertiseandas faras possible,financial support. [n the study villages, the staff at the healthunits and the public service traineeswere under-utilized,as is commonelsewherein Egypt. They welcomedthe opportunityto becometrainersandhealtheducatorsand they performedwell. Nursesprovidededucationat thehealth units during their worki ig hours. Clinic doctors,headnursesandnurseswere usedas trainersfor othernurses,public service traineesandteachers.Theseactivities challengedthe idea,commonly acceptedby bothadministratorsand local people. tlat nothing could be done within theframeworkof thevillage servicesbecausetherewereno fundsavailable.

Thesummerclub programcould be replicatedas summerprogramsarealreadysponsoredby theMinistry of Education,which sometimesalsomakesfunds availableto pay teachersandprovidematenals. In this demonstrationproject,moneyfor staffandsupplieswasprovidedfrom theresearchfund,andcurriculum and teachingguides weie preparedin order to demonstratethefeasibility of the summerclub formatasavehiclefor healtheducation.

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Intersectoral cooperation. Intersectoral cooperation was shown to beessentialfor the successof the various health educationprograms. Thecooperationof staff in many differentsectorsat the village andmarkaz levelwasneededbefore local staffcould train andparticipatein the program;theMinistry of Education for the summer club program; the Ministry of Healthfor theclinic-basedprogramandfor the training of teachers:the SocialAffairsDepartmentfor thepublic servicetrainees.As with the work on interventions,the interactionof theresearchteamwith local andregionalofficials--discussingtheprojectwith them,listening to their views and involving them in trainingandevaluation--helpedto maintain official supportfor theactivity.

Theproceduresinvolved in working with local andregionaladministrationwere often tediousand time consuming. Forexample, it tooka long time,andmany follow up visits by researchersfor all the public servicetraineestoobtain the requiredclearancefrom theMinistry of Social Affairs to train andwork as hygienepromoters,eventhoughtheyhadalreadybeendirectedto therural healthunitandhadnotbeenassignedanyotherspecific tasks.

Oneunresolvedproblemwasthe questionof sustaininginformal groupsof village level hygiene promoters after the researchteamleft. In Egypt, theactivities of local voluntary organizationsare circumscnbedby law, andhaveto be supervisedby anumbrellaorganization.Perhapsthesegroupscouldbepartof the programsupervisedby the local village CommunityDevelopmentAssociations,supportedat the village level by the local representativeof theMinistry of Social Affairs.

Theinsightsgainedin this projectcouldbe incorporatedinto training fornurses,as nursingtraining is carriedout locally in the sevennursingschoolsin Menoufiagovernorate.Training matenalsprepareddunngtheprojectcouldbe used for nursestraining, as well as for in-servicetraining for healthunitstaff. Working through theMinistry of Social Affairs and/or the Ministry ofHealth,materialsandencouragementshouldbegiven to public servicetraineesattachedto health units so that they cancarry out communitybasedhealtheducationon agovemorate-widebasis.

Collaborationwith the sectoralauthoritiesalsomeantsharingexperienceswith them.For example,at a meetingwith Ministry of Health Staff at thegovemoratelevel,healthstaffagreedthat hygieneeducationconstituteda vitalcomponentof pnmaryhealth care. Theheadof oneHealthDepartmentarguedthat healtheducationshouldbetackledin a holistic fashion,contrarytocurrentpracticesin the healthsector. At themomentthereare many differenthealtheducationprojects eachemphasizinga single theme; for example,oralrehydrationasa treatmentfor childhooddiarrhea,nutrition,immunizationand,now, hygieneeducation. Staff membersrecognizedthatseparateprograms,involving training, the preparationof visual aids, andseparateeducationalsessions,waswastefulasall the themeswere soclosely related. Evenif such

75

discussiondid nothaveimmediate:e~olts,it heightenedstaffawarenessof theneedfor newstrategiesin integratecpnmeryhealthcare

The partnership model. ~Je partnershipmodel wasalso relevant forthe healtheducationprogram. Thef nal phase,whencooperationwith localadministrationstaffincreased,wcsin effecttestinga partnershipmodel. Here,themodel includedall thepoteniia beneficiariesof healtheducation(women,childrenand their families), thosewho were trainedand implementedhealtheducation(nurses,public servicetrainees,peergroupeducatorsandprimaryschoolteachers),andlocal administrationstaffwhosecooperationwasneededto implementandsustaintheprograms

The topics addressedin the various health educationprogramswereeffectivebecausethey reflectedcommunityconcernsto improve water andsanitationfacilities in thetwo villages;for example,the needfor garbageandsullagecollectionsystemstokeepthe streetsandcanalscleanandcutdown onthe numberof flies. Somepeoplewere involved in bothsetsof activities;someof the womenactive in repairingstandpipesandsolvingtheproblem ofthe polluted canal were also h’vgicne promoters. This showed that theeducationcomponentwaslinked to the waterandsamtationactivities,andthata two-prongedapproachto environmentalproblems was feasible at thecommunitylevel.

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CHAPTER FIVE

CONCLUSION

The Objectives Accomplished

Thisaction researchproject testedvariousapproachesto implementingwaterandsanitationprogramsin ruralareas,using a holistic,partnershipmodel. Inthis model all players,mainlyat the village level, who haveaninterestin thevariousprojectswere involved: administrators,informal and formal villageleaders,villagers,andthe researchteam.An attemptwasmadeto dealwith thewhole structure,all the participatingpeopleand institutions,and with allprogram processes,including diagnosis, planning, implementationandmaintenance.

The argumentwas that such an approachis a good guaranteeofsustainability. In generalterms, the variouselementsof the model showedconsiderablepotential.

The main objectivesaccomplishedincluded the testing of variousinnovative approaches as means of improving health and sanitation throughlocal participation. Interventions,suchas thosefocusingon standpiperepairandmaintenance,which could be supportedat the village level, were mostsuccessful. In the health education component, the researchteamconcludedthat nurses,community servicetraineesand teacherswereeffective healthpromoters.Women approachedduring the study becamemore awareofsanitationproblems which affected them directly, and more receptivetohygienemessages.

Empowerment of Women

This action/researchprojectreinforcesthe findings of earlier studiesthatwomen shouldbe involved at all stagesof the identification,planning,andimplementationof waterandsanitationprojects. Womenbecamemoreawareof thepossibilitiesof action in the areaof local watersupply,andthedisposalof wastewater and garbage. Women werealso the major participants,aseducatorsandaudience,for hygieneeducation.The projectfound thathealtheducationby womennurses,andby primary school teachersdunngsummerclubs,waseffective. Messagesdeliveredby womenin a numberof differentsocialcontexts,including the healthunit andthe household,helpedto createawider awarenessof hygiene behaviorin thevillage andwererepeatedin manyinformal settings.

77

The processof getting wonier ii volved and interestedandacting as agroup was gradual and time ‘:t nsimtng. It dependedon the gradualdevelopmentof rapportbetweenifie ‘‘omen and the researchteam. Womenwere ableto takethe leadin art ciila ing andactingon a communalneedifthey expenencedthis needpersora] ~y md theactivity did not involve complexadministrativeprocedures.In the cas of the standpiperepair,they stimulatedotherwomento organizein a differeni neighborhood,following their example.However,therole of a facilitator, in our casemembersof theresearchteam,was importantespeciallyin the initial stagesof mobilization for groupaction.

In theEgyptianrural settingat is difficult to identify andfoster leadershipandparticipationby women,becauseof women’s lack of social power,andtheir gendersegregatedactivities wLich arepredominantlyin the domestic,ratherthan thewider public sphere. The involvementof womentakestimeand thesuccesseshereweredueto thesmall scaleand long time spanof theprojecL Theresearchprojectfoci ised on only two villages,andoverfour yearsbuilt on thecommunicationsandknowledgeobtainedduring theprevioustwoyearsof anthropologicalresearch.

Community Involvement

Communityinvolvement,by womenand men,cannotbe forced - it takestime. Initially, thepredommantattitudeof therural peopleaboutwater andsanitation,and other village problems,was: “Let the governmentsolve theproblem.” However,work overa four yearperioddid resultin someactions,in somechangesin attitudesandexpectationson thepartof thevillagers. Thevillagers’networkof social interactionformedthebasisfor activities by thecommunitymembersandby local leadership,bothformal andinformal. Adultwomen and men were involved an various activities, suchas repairing andmaintainingstandpipes,andwastewater andsolid wastedisposal.Childrenwereobservedto haveimprovedthe levels of their personalhygiene,andkepttheir houseand streetenvironmentcleanthrough activities at the summerclub. Only youthcould notbereached.Althougha groupof adolescentboyshad shown someinterestin helping in Kair Shanawanthey did not followthroughwith this suggestion.

The involvementof women.men,andchildrenin activities relating towater and sanitation, took place LII ~. imumberof differentspheresof activity,andwerethusreinforcing. Healthecucationmessagescamefrom anumberofdifferentsourees,from healthpromotersandfrom theaudience,which includedchildren;at the sametime,villagers sometimesthosewho hadbeenactivelyinvolved in health education,were working to improve the local villageenvironment.Village informal andformal leadershipworkedwith communitymembersto supporttheprogram.

7g

In the study setting, therewas little tradition of voluntary action andcollaborationto solve local level problems.Villagers and householdswerepredominantlyindividualistic in their outlook. Thus,therewere no availablemodelsto turn to whenseekingto encouragelocal women to act as healthpromoters,or local womenandmen to form healthassociations.It tooktimefor local women,andalso to a lesserextentfor men,to developthenecessaryconfidence,andpersistence,neededto tacklelocal problems.Many times,anactivity begunwasgiven up in the faceof theobstaclesencountered.

It wasclearfrom a study in only two villages, that local conditionsin avillage, or the neighborhood,can have a considerableimpact on thedevelopmentof participatoryprojects. Babil hadbeendominatedbeforethe1952revolution by one family who remained unpopular m the village and wasrivenby factionaldisputes,with competingfamily andkin groupsseekingtoreplacethe influenceof the single, once-powerfulfamily. Kafr Shanawanappearedto havefew suchnvalnes,andprovedto bea morefertile groundforcommunity action. Thus, for maximum impact, it would appearto beessentialto focuson thosecommunitieswhich are responsiveto the conceptof communityparticipation,and where some individuals commit themselvesto this ideafrom thebeginning.

Somefactorswhich discouragecommunityparticipationmay berelatedtorecentsocial andeconomicchange,but the evidencefor this as it affectsthetwo studyvillages is only anecdotal.The growthof individualism maybe afactor here. In the past,weddingsand funerals were major village andneighborhoodsocial activities and no householdwould think of having awedding soonafter the deathof a residentof a nearby household;suchconsiderationsare less relevanttoday,and life cycle festivalsare pnmarilyfamily and kin affairs rather than neighborhoodactivities. Economicpressures,to maintainliving standardsafterboomyears and,for the fortunatefew, after remunerativework elsewherein the Arab world, focus on thehouseholdanddistract many women and men from a wider communityparticipationand interestin communityaffairs. Increasingly,womensoughtfor morechannelsthroughwhich to earnadditionalcash;andmen often hadmore than onejob. Changingpatternsof leisuremay also havecontributedhere;TV viewing, a major leisurepastime,is largely apassiveactivity, carriedout indoorsandat theexpenseof social interactioninvolvmg neighbors.

Local Administration

All throughthis action/researchproject,activities neededto be clearedwithlocal administration,and their approvalsought. Common administrativeproblemswereidentifiedduring attemptsto develophealtheducationprogramsand to improve waterandsanitationprovisions. Theadministrativesystemis,in practice,highly centralized,andtop-downdecision-makingdrainsinitiative

79

and incentive from local level 2ifl inistrators, who are seensimply asinstrumentsof centralpolicy.

Horizontal linkages are ccrr~spondinglyweak; thus hinderingcommunicationbetweenthe separite authontiesresponsiblefor the wholerangeof water, sanitation,educator arid health issues. Thus, a holis~oc,problem-solving,partnershiporieotatintowardssolving water andsanitationissuesis extremelyproblematicalwithout changesin theorganizationof localadministration.

This projectrevealedthat sir all p~ojects,involving only the village levelauthorities,were ideal targetsfor corrimunity action. Thesecanthereforebetheentry points for developingcommunityparticipation. However, it soonbecomesclearthat, in water andsanilation,a small interventionis linked tootherssuchas the needto improvedrainage,the needfor health education.Therefore,efforts restrictedto this le ~‘elmay quickly reacha ceiling beyondwhich little canbe done,if the exstng systemof local administrationdoesnotbecomemoreresponsiveto local needs.

The needto strengthenthe existing institutions in the environmentalsanitationand public health sectorsis likely to be a long term processrequiringpolicy changeandthe :iifusion of funds,appropriatematenalsandtraining. However, this projec. showed that, in spite of the problemsofadministrativeconstraints,sonic pathwaysfor sustainablechangecould beidentifiedandmappedout.

The Way Ahead

In an initially unpropitiouslocal setting.theaction/researchprojecteffectivelyfosteredthe villagers’participation,voluntary activities,andthe developmentof theirdecision-makingskills. This indicatesthat themodelcanbereplicatedelsewhere,with modificationsto suit local conditions.

The empowermentprocessencouragingthe participationof all membersof thecommumty,especiallywomen,wasonly just startingto takeroot whentheprojectcameto an end. The timetakento developa participatoryethos,on thepartof the womenandmcii in thetwo villages,and the fact that theyeasilybecamediscouragedwhendealingwith local andregionaladministrativestaff, suggestedthat the balanceof the original participatorymodelshouldbechanged.

Theresearchteam,as facilitators,directedmostof their attentiontowardsthevillagersandtheir needs,andneglectedthepotentialities,constraints,andprocessesof the governmentpersonneland organization. Identifying themanagementstructure,as in Ihis oro~ect,is only the first stage in thedevelopmentof a partnershipmodel. A betterunderstandingis neededof theprocessof decision-makingat all leveLs andby all actors,andof thenatureofthehorizontal,verticalandintersectoialinformationnetworks.

8’)

Thechallengepresentedby theaction/researchexperienceis to incorporatethe lessonslearned,principally those concerningthe role of the localadministration,and further developthe partnershipmodel. Such a modelshouldmoveaway from the usual romanticismof standingon the sideof the“weak”, i.e. the villagers, towardsa new perspectivewhich focuseson therelationshipbetweenall the actorsinvolved,a relationshipwhich entailsmutualunderstandingandpartnershipratherthannvalry.

As an outcomeof this study,a follow-up two yearresearchprojectiscurrently being funded by the InternationalDevelopmentResearchCenter(IDRC). Thisprojectis focusingon Kafr Shanawanwheretheconditionsforcontinuedcommunityand local administrationinvolvementweredeemedmostsatisfactory. Thestudy, “CommunicationProcesses:anavenuefor sustainingimprovedhealthand sanitationpractices”,is being camedout by the sameresearchteam. It is focusing on the communicationprocessitself, bothwithin and betweenthe variousbureaucraticdomains,which canaffect theability of thecommunitymembersto initiateandsustainpositivechangesinhealth andsanitationpractices. Decisionmakersandadministratorsin thegovernorateandmarkaz representingdifferentdirectoratesanddepartmentswerenot involved from the beginningof theaction/researchprocess,andoftenlackeda clearunderstandingof theirimportancein the implementationprocess.Having decipheredsome of the bureaucraticprocessesrelatedto villageprojects,theresearchteam is now focusing on the communicationlinkages.Thereneedsto bea cleartwo-waynetworkingsystembothwithin andbetweenthe vanous bureaucraticdomains,which can affect the ability of thecommunity membersto initiate and sustainpositivechangesin health andsanitationpractices.

The new model incorporatesall actors with an interest in andresponsibilityfor water andsanitationat the village level: villagers,formaland informal village leaders,facilitators,and administratorsat the village,markaz andgovemoratelevel. Theproject will presenta casestudyof thecommunicationprocessesnecessaryto sustainimprovementin health andsanitationpractices. The immediatebeneficiariesof tl~eprojectwill be thevillagers in Kafr Shanawan,who arepartnersin the process. It is anticipatedthat, oncehaving identifiedcurrentobstaclesand themeansof overcomingthem, village councils and community members, together with theadministratorsand decision-makers,will work togetherin sustainingandbuilding upon the gains madeduring the life of the first action/researchproject.

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APPENDIX 1PROCEDURES INVOLVED IN PREPARTh~GA FEASIBILITY STUDY

TO LOWER THE WATER LEVEL IN KAFR SHANAWAN

Date Villagers’ Participation Role of Policy Makers IssuesDiscussed Follow up

31/7/87 Meeting with 50 menalter - Village sanitaryproblems& suggeste R T will invite thespeciali- Fndayprayerat themosqu solutions (e g sullagecollection sys-

tern, installationof tanks)was dis-cussedwith villagers.- Villagers readyto contributemoney toestablish a seweragesystemin the vil-age- Villagers summed up the main sanitaryproblem in ihc vii.Lige a~thehigh wa1c~table which is dueto a) excessiveuscov,acA.~) t~ lc~C1C ation of th ~

51 ersgineeerto further discu-ss these suggestions

I

28/8/87 A WHO engineerconsult-ant met with the Mayor &around~0 villagersin thevillage guesthouse

After walking aroundthevillage, it wasproposedto- establisha pipednetwork to reduceth~thelevel of groundwatertable.- Thenetworkwould serveasa basisfortheseweragesystemfor the wholevil-lage in thefuture- The networkexpensesare estimatedto be LE 100,000.- Villagers will form sub-committeestofurtherdiscusstheproposedsystem&

00

Date Villagers’ Participation Role of Policy Makers IssuesDiscussedFollow up

28/8/87 be in charge for raising the necessaryfundsfrom the villagers

From Sept 6 to Sept 30, 1987, severalmeetingswere held with theHeadof V C & somevillagers The sub-committeehasbeen establishedbut it

was not possiblefor thevillagers alone to fund sucha project However,ths~financial inability did not underminetheir enthusiasmfor the project.Higherauthoi ties will beapproachedto ft d theproject.

2 1/10/87 Meeting at the agriculturalcooperativewith 3 men,RPVC,youth representat-ive & mosqueimam

Headof V C ,DireciorofAgnculturaiCoop & Headofpolice stationattendedthemeeting

Discussionsconcentratedon thepro-posedsolutionsto the village sanitaryproblems Villagers were notified aboutcoming govemoratemeetingwhich wilinvolve representativesof thedifferentdepartmentsconcerned.

R T promisedvillagers toraise their problemswithhigherauthorities& tosharewith them the resultsof that meeting

26/10/87 RI met at thegovemoratewith the Vice Minister&GeneraiSecretaryof MenouliGov & representativesfromtheHealth,Social Affairs,Education& Developmentdepartmentsat govemoratelevel, headof Tala city

It wasdecidedthat no furtherseweragesystemslike the oneproposedfor K Scould beexpenmentedin Menoufiabe-fore theresultsof 2 similar experimentsystemsin thevillagesof Kom ciAkhdar& Saheiei Gawaber,Menoufia,areknown. The role of R.T couldbedirectedto presentinga feasibility stud:for a seweragesystemin K.S thatcouldbeconsideredin thefuture.

R T would form a technicalteam to presenta feasibilitystudyfor a seweragesystemin K S

Date Villagers’ Participation Role of Policy Makers IssuesDsscussed [i~ollow up

Resultsof the govemoratemeetingwe4sharedwith villagerswho wereenthusiastic to cooperate& provideany helpneeded.

30/10/87 Meetingwith morethan 5~villagers at themosqueafterFnday prayer

During the period from Nov 6, 1987 to Jan 3, 1988, severalmeetingswere held with the village Mayor, Headof / C, Director of DevelopmentDepartmentat govemoratelevel, RPVC andsomevillagers to arrangefor the technicalteam that would be responsiblefor presentingthe seweragesystemfeasit lity study

8/1/88 R T & 2 environmental Headof V C , Diiecxorof OR- The teamandtheofficials movedaround Collecting the neededinfor-engineersattendedameet- DEV at govemoratelevel. Di tnevillage It w~ssuggesteddesigmng mation& arraxsgnig~

ing with 4 village informs of EngineenngDept. at Gov. theseweragesystemto make it feasible anothermeeuiigleaders,ORDEV represent- ievel attendedthemeeting to haveall housescO~TIflCCtCCito ii.ative, & cagineenogdeçt~ Basicdatathat is requiredto designthehead of PVCatgovemorat system will beprepared.level

I 1During theperiod from Jan.24 to Feb 3, 1988, severalmeetingswere hi d with villagers, Headof V C. & the Dirt ~iorof ORDEV atgovemoratelevel. The required data was presentedto the engineer.As it was necessaryto involve the Irrigation Dept. in the design, representativeswereapproachedt attendthecoming meeting.

5/2/88 RI & the2 environment- Headof V.C ,Dir. of ORDEV The design of theseweragesystemwas R.T with technical earnal engineers met with 5 at govemoratelevel & repre- discussed.The systemwill beestablish- completedall datarequiredvillage leaders,Headof P sentativesfrom theEng & eedover 2 phasesa) PhaseI theesiab- for thedesign& thesewereVC at govemoratelevel & Im Dept. at gov level at- lishment of a pipednetwork to reduce submittedto theengineerinthe village Mayor tendedthemeeting thehigh groundwatertable, b) PhaseII. in Feb 16, 1988

Date Villagers’ Participation Role of Policy Makers IssuesDiscussed Follow up

5/2/88 Adding a treatmentplant & connectingthewhole villageinto the seweragenet-work Furtherbasic data & measurementarereqwred

From Feb 21 to March15, 1988, R T. met severaltimes with theDirectorof ORDEV at gov level, Headof PVC, I-lead of V.C, Director of irrigationDept at govemoratelevel and the engineer who is responsiblefor thedesignof the system Iwo main issueswere the focus of thesemeetings:a)Geetingthe Irrigation Dept. approvalfor theproject aslong as it doesnot violate rules stipulatedin law 48, 1982; b) Fundallocation for theprojectas themembersof PVC refusedto allocateall the budgetfor Kafr Shanawanvillagealone Directorof ORDEV suggestedthat all proposedprojectsforthe villagesof Shanawanand Kafr Shanawanare to besubmittedto the DepL and it is up to its membersto decidewhich projectswill be covered bythe govemoratefund Finally, the consultingengineerpresentedhis preliminary sketchand he promisedto finalize the whole design in a ten-dayperiod

30/5/88 Informal andformal lead-cc met with the engtneennconsultant

The Eeec Village Councilmemberwas notified of thedesign

As a first stepengineersubmittedadesignto establishpiped network&reducethe watertable

June88 membersof thepopularcouncil - 3 representatives

Meeting with electedV C &popularVC. of Shanawantodiscuss issueof funding.

Discussedthepossibility of introducin~thefeasibility studyfor partial fundingfrommoneyallocatedfor village infra-stricture It wasturneddownby themajority, theywill only approveti if

the plan is to includethe mothervillageof Shanawanaswell

00Lu

Date Villagers’ Participation Role of Policy Makers IssuesDiscussed Follow up

20/7/88 The Mayor & KS villageleadersmet with therepre-semativesof the NationalDemocraticparty.

Decidedto presenttheissueto the govemorate

It wasdecidedthat a groupof themfor-mal leaderswith the representativestothepopular councilwill try to seethegovernor

The R.I tried to follow upthids issue with villageleaders.

Nov 88 A delegationfrom thevil-lage

Meeting with the governor The delegationpresentedtheir request,in turn thegovernorreferredthecasetothemarkaz ExecutiveCouncil

Dec 88 A delegationfrom thevii- Presentedthedesignto Head~ ~ .t~nfn,mi) of rnarkaz Fixec C

I leaders& the R T.

In themeeting thedelegatesexplainedtheissue.Headol MEC wasnot satss!iebecausetheycompletedthe feasibilitystudywithout consultinghim

I

Feb 89 Meetingat the V C It wasdecidedthatthefeasibility studymust be integratedto include themainvillage of ShanawanVillagers express-edwillingness to pay for the expenses

Feb. 89 Village leadersmet withengineeringconsultant.

Engineerdecidedto addm thedesignShanawanfor theactualCostLE 12,00Villagers agreedto raise theamount&askedhim to go aheadasrequested.

TheRI. tried to follow upthis issue with villagers &consultant

June89 Village leadersmet withmembersof the ComunityDevelopment Association

The main issue wasto openon accountin thebank for contributions from vii-lagers for the project

Issue still understudy

APPENDIX II

TRAINING MATERIAL FOR HYGIENE PROMOTERS

Preparedby Dr. Mofida Kamal, healtheducationconsultant.Translatedfrom

Arabic.

GENERAL HYGIENE

What is the environment?Theenvironment can be divided into two spheres:i) external,outsidethe home;ii) internal, lnsidethehome.Theexternalenvironmentincludesthe land, airandwater.Theinternalenvironmentis whatprevailsinsidethehome.

How is the environment polluted?Theexternalenvironment:Theair canbepollutedfrom dust,cars,etc.Canalwater15 pollutedfrom garbagedisposal,deadanimals,washinganimals,child andanimalexcrete.Theinternal environment:Water storage: What runningfrom taps is clean. However, it caneasily bepolluted. How?1) Dustandflies canpollute a containerwhile it is beingcamedhome.2) Dirty handsthatcomeinto contactwith thewatercancontaminateit.3) Water that is stored uncoveredis exposedto flies, dust, andpoultry, all ofwhich canpollute it.4) Drawingwaterfrom the waterstoragecontainercanpollute it, if thepotusedis notclean.

How to Store Water in a Hygienic Manner1) Water shouldbe storedin a clean,coveredcontainerelevatedabovetheground.2) Thepotusedfordrawingwaterfrom the storagecontainershouldbecleanandhavea longhandle.3) Cleanhandsshouldbeusedwhendrawingwaterfrom thecontainer.4) Unusedwater should not be returnedto thecontainer.

Food PreparationPreparingfood in a hygienicmanneris of greatimportance,to avoid thespreadof germsandmicrobes.1) Rmseutensilswith cleanwaterimmediatelybeforeuse.2) Theareafor cooking shouldbefreefrom dustandaway from animals.3) Left-overfood shouldbecoveredandstoredin anelevated,coolplace.

s7

4) It is essentialto boil cows’mill: b fore feedingit to infants.5) Infant food shouldbepreparec.b::fo e eachfeed.6) Vegetablesshouldbe washed vii ~cteanpotablewater,not canalwater.They shouldbe cleanedby pouring wa eroverthem,e.g. from a tap.

Hand WashingHandsshouldnot bewashedin a how or plate,butunderrunning waterfroma tap,or by pouringa glassof watero’er thedirty hands.Washinghandsin abowl meansthat thedirt from thehandsi~transferredto the waterin thebowlwith all themicrobesandbacteria. lJsing the samewater then transfersthemicrobesto the handsagain. iThal. is why it is importantto pour water overthe hands.It is importantto usesoapin handwashing. If there ts no soap,the ashfromthe oven canbe used.Handsshouldbe washedbefore prepanngfood, feedlng infants; andafterpreparingdungcakesor usingthe intnne.

Preparation of dung cakesDung cakescan causediseasessuch as diarrheaanddysentery. A separategalabzya should be kept specially or this task. The galabzya should bewashedwith soapperiodically. Immediatelyaftercompletingthepreparationof dungcakes,thegalabiya shouldb~takenoff. Alter preparingdungcakes,careful washingof the handswih soap, especiallyunder finger nasis, isimportant.

House CleanlinessThe houseshouldbesweptdaily aodkept free from flies. Chickensandducksshouldbe kept in a specialroom, orchicken house,i. e. not allowedto movefreelyaroundthehouseandtransrnt microbes.Theanimal barnshouldbe a separateroom in the house,andits door shouldalwaysbeclosed.Garbageandtrashshouldbedisposedof frequentlyand/orburned.The facesof infantsshouldbecoveredwith a light cloth or net to protectthemfrom flies while sleeping.

Latrine cleanlinessThe latrine is a major sourceof miciabeswhich help in diseasetransmissionThat is why it lS important to keep the latrine clean. It shouldbe washeddaily andgaspouredon it. A coverv,’ith a longhandleshouldbeplacedon thelatrine openingat all times. Then shouldalso be a smallcontainerof waterin the latrinefor washinghandsafterdefecating.Chlldren shouldbe preventedfrom defecatingin the street. They are to betrainedto usethe latrine. If they ar~too young, a hole nearthe housecanbeused,but it mustbe filled imniedatelyafter use. Vomit shouldbe sweptandcoveredin dust.

88

Disease TransmissionThe focusis on diseasethatcanbe transmittedvia pollutedwater and food,such ashepatitis,dysentery,typhoid. All of theseare morecommonduringthesummer,becauseof flies which transmitthe microbes.

InfectionInfection canbeeitherthroughexcreteor vomit. The microbes(which carrythedisease)aretransferredthroughexcreteor vomit.Thesemicrobescanbe transmittedto a healthypersonthrough:* pollution of waterby the sourceof thesemicrobes;* pollution of handsby thesemicrobes;* thesickpersonwho defecateswithoutwashinghis handsafterwardsand then

touchesthe foodwhich othersmayeat;* flies which carry the microbesfrom theexcreteor vomit to food, handsormouthof otherpeople.

SymptomsSymptomsof thesediseasescaneitherappearimmediately,like diarrheawhichappearsthe dayafterthemicrobereachestheperson’sbody;or symptomsmayappearafter oneweek,suchas dysentery;or after a month, as in thecaseofhepatitis.

Protection from diseases* Cover food to protectfrom flies;* Washhandsbeforepreparingfood;* Preventdefecationin thestreet;* Washhandsafterdefecating.

HYGIENE MESSAGES

The hygienemessagestackle the different themesthat wereselectedas thefocusof theHygieneEducationProgramcarriedoutby thedifferenthygienepromoters.

Latrine CleanlinessLatrineopeningshouldbecoveredsoasto:* avoidthespreadof microbesto theentirehouse;* avoidbadsmell;* avoidflies andinsects.

Cleaningof latrineshouldbeasfollows:* the latrineshouldbe washedandcleanedat leastoncea day;* pour waterdaily downthe latrine, possiblyusedwaterfrom thewashingof

clothes;* pour gasolinearoundtheopeningsoasto:kill microbes;providebettersmell;

89

preventflies andinsects.A containerof water for handwrs~in~shouldbe placed in the latrine, andfilled andcleaneddaily.Washhandswith soapafterusing h li trire.Thedoorto thelatrineshouldalwry~bekeptclosed.If thereis no latrinein thehouse:* handsshouldbe washedwith soapand waterafterdefecatingandurinating;* excreteshouldbecoveredwith des;* gasolineshouldbepouredon it to avoidbadsmell.

Storing of Water Used for Drinking and CookingThe waterstoragecontainershouldbecoveredin order to:* avoid thepollution of waterwith cus~while sweeping;* avoidwaterpollutici from pigeorremainsetc;* avoidwaterpollution from flies

A cleanpotshouldbeusedfor drawingwaterfrom container.A long-handledpotshouldbeusedto drawwaterfrom thecontainer,to ensurethat thehands,if dirty, do notconiactandpollutethe water.Cleanhandsbeforedrawingwater.Thewaterremainingin thepot slio’ild not be putbackin the container,so asto avoidthetransmissionof microbesto the storedwater.

ZaribaThezariba shouldbecleanedperiodicaily.Thedoor to thezariba shouldalwa~sbekeptclosed,in orderto:* preventthe animals from going in.o the houseand spreadtheir remains,which areoneof themajormicrobeso.jrces;* preventchickensandchildrenfrom spreadinganimal remainsinto therestofthehouse;* preventthespreadof thebadsmellintothe entirehouse;* preventthe spreadof flies frorr the zariba into therestof thehouse,asthe

flies transmitmicrobes.

Chicken RaisingChickensshouldbekept in a spec~ficplace,suchas a hen-house,to preventthem from movingfreely aroundthe house,in orderto:* preventchickensfrom carryingdirt ihiough thehouse;* preventchickensfrom polluting foo or storedwater.

Preparing Dung CakesCarefullywashyour handswith soapafterpreparingdung cakes.Immediatelyafterfinishingmakingdung cakes,changeyour galabiya andputit in the sunto dry.Washthegalabiya atleastonceaweek.Avoid preparingdungcakesif you haveacut on yourhand.

90

Food PreparationWashyourhandsbeforepreparingfood.Washcookingutensilsbeforecooking.Washvegetablesoneby oneunderrunning water.Avoid cooking in a dirty part of the house,so that food will not be pollutedby dust,chickensetc.Thestoveshouldbeplacedaway from childrensoasto avoidbumaccidents.The food shouldbe covered to avoid contactwith flies, which transmitmicrobes.

Home CleanlinessThe houseshouldbesweptdaily.Disposeof garbageandwastewaterfrequently.To avoid microbetransmission,combatflies by usinggasolineorchemicals.Pourwateron thegroundaroundthehouseto preventdust.Ventilatethehouseproperly.Preventchildrendefecatingin or aroundthe houseor yard.

ENVIRONMENTAL SANITATION

Irrigation CanalsPolluted canals can be a source of diseasetransmission,especiallyschistosomiasis.Do not throw garbage,sullage,deadanimals,orsewageintothecanals.Avoid using thecanal for washingof utensilsor clothes,since contactwithcanalwatermay resultin schistosomiasisinfection.Childrenswimming in the canalhavea highrisk of schistosomiasisinfection.

Hand PumpsTraditionalhandpumpsare still widely used,thereforeit is importantto followsomebasicstandardswheninstalling them.* Pipesshouldbe installedat least 15-20metersdeepto avoidsurfacewatercontamination.* The site shouldbe carefullyselected,at least30-40 metersfrom latrine pit,soas to insureprotectionfrom fecalcontamination.

Streets and Alleysit is importantto keepstreetsand alleys in the village free from solid waste,dung, and feces,since theseattract flies and mosquitoes,which transmitdisease. This problem can be avoidedby initiating solid wastecollectionsystems,orburning non-recyclablematerial.

Note: Magneticboardson homehygieneandenvironmentalhygienewereusedassupportingmaterial

91

APP EINIDIX III

GLOSSARY

Village

SubVillage or Satellite (,,i�) ~iiJ ~aL~

Hamlet,Ezba

MotherVillage ç~I~ I

VillageExecutiveCouncil 11,,IU ~ L,4~..LI

Village PopularCouncil ~~L~LI i~’. II

Chairmanof Village Council (L~1~LILi~JI ~ t~iJI ~ ~

AgriculturalCooperativeSociety ~_~I~JI L~~1~JI~---II

Social Unit L~L~~I .~JI

Community DevelopmentAssociaticn - I ~. .~ ~—..---.-

Village HealthUnit LLL~JI~ ~

Sanitarian

Village Mayor, Omdah ~~ I

Village MeetingPlace,Madiyafa __.t I

Animal Shed,Zeriba

District,Mar/car

PubhcServiceTrainee ~L*iI L~j.JI~Wj.

Govemorate,Muhafsa ~J~iL~LI

HousingDirectorate,Mudenya I

92

HealthDirectorate

Public Works& ImgationResources

WaterUtilities Directorate

TransportationDirectorate

Ministry of LocalAdministration

Organizationfor theRuralDevelopmentof

EgyptianVillages(ORDEV)

~II ~ ~

L~UIj,,I,,JJ , ~ J1~~J

~L~1Ij~

~JIJi~JI~~

~.�~JI~J’.L~

~1f~

93

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98

ABOUT THE AUTHORS

Samiha el Katsha is Senior Consultantat the Social ResearchCenter,TheAmencanUniversity in Cairo.

Susan Watts is Senior Researcher at the Social Research Center, TheAmericanUniversity in Cairo.

99

CAIRO PAPERS IN SIPCIAE ~CI~E~1CE~~ ~j~1~JI~ ‘Y4~/

VOLUME ONE L977-19781 WOMEN, HEAlTH AND DEVELOPMENT, CynthiaNelson,ed2 DEMOCRACY IN EGYPT,Alt E HLIIa1Lessouki,ed.3 MASSCOMMUNICATIONS AND Th I CCI’OBERWAR, Oifat HassanAgha4 *PJJ~ALRESETTLEMENTIN EGYPT.Hs~iniyTadros5 SAUDI ARABIAN BEDOU[N, SaadE Ilrahmi andDonaldP. Cole

VOLUME TWO 1978.19791 ‘COPING WITH POVER1Y [NA CAIROCOMMIJNITY, AndseaB. Rugh2 ‘MODERNIZATION OFLABOR IN THE ARAB GULF,Enid Hill3 STUDIESIN EGYPTIAN POLITICAL EC3NOMY,HerbertM Thompson4 LAW AND SOCIALCHANGE IN CONTEMPORARYEGYPT,CynthiaNelsonandKlaus

FnedrichKoch, eds.5 THEBRAIN DRAIN IN EGYPT,SaneyaSaleh

VOLUME THREE 1979-19801 ‘PARTY AND PEASANTIN SYRIA. ~al’mofLdHinnebusch2 ‘CHILD DEVELOPMENT IN EGYPT N1 :hoiasV Cia ccio3 *~J\Tll~J(3WITHOUT WATER.Asaa&l Nadime~ai4 EXPORTOFEGYPTIANSCHOOL TEACHERS,SuzanneA Messiha5 * POPULATIONAND URBANIZATION IN MOROCCO,SaadEIbrahim

VOLUME FOUR 1980.19811 ‘CAIRO’S NUBIAN FAMILIES, PeterGe.ser2&3 ‘SYMPOSIUM ON SOCIALRESEARCHFORDEVELOPMENT PROCEEDINGS.Social

ResearchCenter4 *\~()~{~~AND WORK IN THEARAB WORLD, Eari I~.SullivanandKanmaKorayem

VOLUME FIVE i9821 GHAGAR OF SE’TTGIJIRANHA A SFUDYOFA GYPSYCOMMUNITY IN EGYPT’, NaM

Sobhi Hanna2 ‘DI~fl~Jfl1J’flONOFDISPOSALINCOMEAND THE IMPACT OFELIMINATING R)OD

SUBSIDIESIN EGYPT,Kanma Korayem3 *J~COME DISTRiBUTION AND BASIC NEEDSIN URBAN EGYPT,Amr MohieEl-Din

VOLUME SIX 19831 ‘THE POUTICAL ECONOMYOFREVOLUTIONARY IRAN, MihssenKadhim2 ‘URBAN RESEARCHSTRATEGIES [NEGYPT,RichardA Lobban,ed3 NON-ALIGNMENT IN A CHANGINGWORLD, MohammedEl-SayedSehm,ed4 ‘THE NATIONALIZATION OFARABIC AND ISLAMIC EDUCATIONIN EGYPT DAR

AL-ALUM AND AL-AZIIAR, Lois A Anoan

VOLUME SEVEN 19841 ‘SOCIAL SECURITYAND THEFAMIL t’ iN EGYPT,HelmsTadros2 ‘BASIC NEEDS,INFLATION AND THE POOROF EGYPT,Myrette El-Sokkaiy3 ‘THE IMPACT OFDEVELOPMENT ASSISTANCEONEGYPT,EarlL Sullivan,ed4 ‘IRRIGATION AND SOCIETYIN B JRAL EGYPT,SohairMehanna,RichardHuntmgton

andRachad Antonius

VOLUME EIGHT 19851&2 ANALYTIC INDEX OFSURVEY RESEARCHIN EGYPT,MadshaEl-Safty,MontePalmer

andMark Kennedy

VOLUME NINE 19861 PHILOSOPHY,ETHICSAND VIRTUOUSRULE,CharlesK Butterworth

2 THE‘JIHAD’ AN ISLAMIC ALTERNATIVE IN EGYPT,NematGuenena3 *~flThINSTITUTIONALIZATION OFPALESTINIAN IDENTITY IN EGYPT,Maha A

Dajani4 *5()QAJ, IDENTITY AND CLASSIN A CAIRONEIGI-IBORIIOOD, NadiaA Taher

VOLUME TEN 1987*ALSA~4WJPJAND ISLAMIC LAW, EmdHill

2 GONEFORGOOD, RalphSell3 *‘fl4~CHANGING IMAGE OFWOMEN INRURAL EGYPT,MonaAbaza4 INFORMAL COMMUNITIES IN CAIRO THE BASIS OFA TYPOLOGY, Linda Oldham,

HaguerEl Hadidi, Hussein Tamaa

VOLUME ELEVEN 1988I PARTICIPATIONAND COMMUNITY IN EGYPTIANNEW LANDS THECASE OF

SOUTH TAHRIR, Nicholas Hopkins et al2 PALESTINIANUNIVERSITIES UNDER OCCUPATION, Antony T Sullivan3 LEGISLATING INFITAH INVESTMENT, FOREIGNTRADE AND CURRENCYLAWS,

Khaled M Fahmy4 SOCIAL HISTORYOF AN AGRARIAN REFORMCOMMUNITY IN EGYPT,ReeniSand

VOLUME TWELVE 1989I CAIRO’S LEAP TORWARD PEOPLE, HOUSEHOLDS AND DWELLING SPACE,Fiednc

Shorter2 WOMEN, WATER AND SANITATION HOUSEHOLDWATER USEIN TWO EGYPTIAN

VILLAGES, Samiha El-Katsha et al3 PALESTINIAN LABOR IN A DEPENDENTECONOMY WOMEN WORKERSIN THE

WESTBANK CLOTHING INDUSTRY,RandaSimon4 THE OIL QUESTIONIN EGYPTIAN-ISRAELI RELATIONS, 1967-1979A STUDY IN

INTERNATIONAL LAW AND RESOURCEPOLITICS,KanniWissa

VOLUME THIRTEEN 1990I SQUAYFER MARKETS IN CAIRO, HelmsR Tadros,MolsamedFeteeha,Allen Hsbhard2 THESUB-CULTURE OF HASHISH USERSIN EGYPT A DESCRIPTIVEANALYTIC

STUDY, NashaatHassanHussein3 SOCIAL BACKGROUND AND BUREAUCRATIC BEHAVIOR IN EGYPT, Earl U

Sullivan,El SayedYasssn,Ali Leila, MontePalmer4 PRIVATIZATION’ THEEGYPTIAN DEBATE,MostafaKamel E1-Sayyid

VOLUME FOURTEEN 19911 PERSPECTIVESON THE GULF CRISIS, Dan Tschirgi and BassamTsbi2 EXPERIENCEAND EXPRESSIONLIFEAMONG BEDOUIN WOMEN IN SOUTHSINAI,

DeborahWickenng3 IMPACTOFTEMPORARYINTERNATIONAL MIGRATION ONRURAL EGYPT,Aid

HannaNada4 INFORMAL SECTORIN EGYPT,Nicholas S Hopkins ed

VOLiJ~VE FIFTEEN, 1992I SCENESOFSCHOOLING.INSI] )E ~G~RLS’SCHOOLIN CAIRO, Linda Herieea2 UREANREFUGEES~TH1Of-L~NS ANi) ERITREANS IN CAIRO,DereckCooper3 INVSTORS AND WORKERSI~’‘HI WFSTERNDESERTOFEGYPT AN

EXPLORATORYSURVEY, lae m Sherbmy,DonaldCole, NadiaMakaiy4 ENVIRONMENTAL CHALLEr’4(iF~ IN EGYPTANDTHEWORLD, NicholasS Hopkins.

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