REPORT - Home page | UNICEF · 1 REPORT Cultural and Behavioural Barriers Analysis for Positive Sanitation and Hygiene Practice and Material Development Prepared By Emily Samuel

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REPORT

Cultural and Behavioural Barriers Analysis for Positive Sanitation and

Hygiene Practice and Material Development

Prepared By

Emily Samuel

27th August 2015

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Acknowledgement

I would like to put on record appreciation and thanks to UNICEF Eritrea Country Office and to

Dr Zemui, Director, Environmental Health, Ministry of Health, Eritrea in entrusting to me the

important task of carrying out the Cultural and Barriers analysis for Sanitation and Hygiene.

I would like to recognize the continuous support given by Ms Awet Araya, Communication for

Development Officer, Mr Martin Worth, Chief of Wash section and Mrs Yirgalem Solomon,

Wash Specialist to successfully complete this study.

I would like to especially thank and acknowledge all the efforts put by the study team Tekie

Abraha, Abraham Milash, Aman Girmai, Asmeret Teslayohannes, Martha Tesfai, Yodit Tekeste,

Bereket Mosazqhi and Habtom Solomon in carrying out the data collection process.

Emily Samuel

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Table of Content

Acknowledgement

1.Rationale and Background ...................................................................................................................... 5

2.Objectives of Study .................................................................................................................................. 6

3.Study Design ............................................................................................................................................. 6

4.Selection of Study Sites ............................................................................................................................ 7

5.Methodology and Tools ........................................................................................................................... 8

6.Literature/Documents Review ................................................................................................................ 9

7.Data Collection, Transcriptions, Summarization and Analysis ......................................................... 11

8.Limitation of the Study .......................................................................................................................... 12

9.Findings of Barriers analysis ................................................................................................................ 13

9.1 Tigrinya Ethnic Group .................................................................................................................... 14

Water Handling & Use ......................................................................................................................... 15

Latrine Coverage & Use ....................................................................................................................... 16

Handwashing and Face washing ........................................................................................................... 18

Food Hygiene ........................................................................................................................................ 19

Environment Cleanliness ...................................................................................................................... 19

The channel of communication preferred by community ..................................................................... 19

Messages to Address Barriers ............................................................................................................... 20

9.2 Tigre Ethnic Group ......................................................................................................................... 24

Background ........................................................................................................................................... 24

Water Handling and Use ....................................................................................................................... 24

Latrine Coverage and Use..................................................................................................................... 25


Channel of communication ................................................................................................................... 26


9.3 Saho Ethnic Group .......................................................................................................................... 31

Background ........................................................................................................................................... 31


Latrine coverage and Use ..................................................................................................................... 32

Handwashing & face washing .............................................................................................................. 32



9.4 Afar Ethnic Group ........................................................................................................................... 38

Background ........................................................................................................................................... 38

Water handling and Use ........................................................................................................................ 38

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Personal Hygiene .................................................................................................................................. 39

Environment ......................................................................................................................................... 39


9.5 Rashaida Ethnic Group ................................................................................................................... 44

Background ........................................................................................................................................... 44



Handwashing ........................................................................................................................................ 45


9.6 Kunama Ethnic Group .................................................................................................................... 49

Background ........................................................................................................................................... 49



Handwashing ........................................................................................................................................ 50



9.7 Nara Ethnic Group .......................................................................................................................... 55

Background ........................................................................................................................................... 55


Latrine coverage and use ...................................................................................................................... 55


Environment ......................................................................................................................................... 56


9.8 Hidarb Ethnic Group ...................................................................................................................... 61

Background ........................................................................................................................................... 61

Water Supply and Use .......................................................................................................................... 61



Environmental Cleanliness ................................................................................................................... 62

9.9 Bilen Ethnic Group .......................................................................................................................... 63

Background ........................................................................................................................................... 63

Water Handling & Use ......................................................................................................................... 63


10. Recommendation ................................................................................................................................. 64

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1.Rationale and Background

WASH is a central component of the millennium development agenda. The Joint Monitoring

Programme report, Progress on sanitation and drinking water: 2015 update and MDG

assessment, says worldwide, 1 in 3 people, or 2.4 billion, are still without sanitation facilities –

including 946 million people who defecate in the open. Without significant improvements in

sanitation access and hygiene practices, goals related to child mortality, primary education,

disease reduction, and poverty eradication will not be achieved1.

The Government of the State of Eritrea and UNICEF are implementing various initiatives to

improve the people’s access to water and safe sanitation facilities and to promote hygiene

practices. The Community-Led Total Sanitation (CLTS) approach in 2008 to accelerate the

sanitation coverage focused mainly on achieving sustained behaviour change through various

participatory tools and techniques to help communities realize the risks associated with open

defecation and to promote actions leading to construction and use of household latrines built by

locally available materials without any form of subsidy on the hardware component. But a lot

remains to be done to reach the MDG goal of 54% latrine coverage by 2015.

In May 2012, UNICEF commissioned a nationwide Knowledge, Attitude and Practice (KAP)

survey on Hygiene and Sanitation in six zobas- Regions. The following is the summary of the

main findings:

Regarding water handling and use, indicates in rural areas 52.8% use unimproved water

sources which includes (unprotected public well, river or stream, bottled water and other

unimproved sources).

Sanitation coverage in Eritrea is low with still 47.3% who do not have access to latrine.

Over 75 % of the rural population defecate in the open.

The critical hand washing times presented in this report were times of hand washing

before eating, after defecating and before preparing or handling food. However, study

suggests that of the existing latrines (76.7%) were observed to have no hand washing

facilities.

On food hygiene the results indicate that the community has good knowledge of making food is safe for eating by covering the food, reheating before eating, proper cooking and

immediate consumption after cooking.

Findings also revealed communities have good practice of cleaning their compound/yard.

In 2013, the results of the KAP survey results were used to inform the development of a

communication strategy for Hygiene and Sanitation (2013-2016). The communication strategy

was designed to provide a road-map for planning, implementation and monitoring of the

sanitation programme.

In response to the above, there was a felt need to conduct a formative research to identify more

specific cultural and behavioral determinants which are barriers to Sanitation and Hygiene

practice. The formative research will assist the programme through specifically providing

1 http://www.unicef.org/wash/index_bigpicture.html

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evidence based behavior change communication messages to overcoming the identified barriers

that would improve and sustain positive Sanitation and Hygiene behaviors.

2. Objectives of Study

The objectives of the barriers analysis study established in the Scope of Work are as follows:

To identify the specific behavioral determinants which are barriers to good sanitation

and hygiene;

Propose appropriate evidence based and context specific messages which will assist in

overcoming the identified barriers;

The barrier analysis will establish detailed information on determinants of five pillars of

WASH:

Household water treatment and use,

Low utilization of sanitation and hygiene services,

Personal Hygiene (Hand washing and face washing)

Food Hygiene

Environment cleanliness

Based on the findings of the study and in line with the current programme approaches, draft key

messages will be reviewed and revised. And specific messages will be developed to overcome

the cultural barriers identified by the study amongst the various ethnic groups.

3. Study Design

The research design is broadly following the formative research methodology using to generate

information from the intended groups.

The formative research used the SaniFOAM framework as a means of organizing and analyzing

the behavioral determinants as shown in the diagram below. Behavioral determinants are the

factors that can facilitate or inhibit a behavior of interest among a certain population. For

sanitation, these determinants can be internal (such as beliefs about feces) or external (such as

social norms and sanctions for open defecation). Tools and data collection approaches have been

selected and tailored accordingly to address research hypothesis developed with the health staff

and programme They are broadly explained here below;

Opportunity: Institutional or structural factors that influence an individual’s chance to perform

a behavior. Determinants within Opportunity include: access/ availability, product attributes,

social norms and sanctions/enforcement. The key question here is does the individual have the

chance to perform the behavior?

Ability: An individual’s skills and proficiency to perform a behavior. Determinants within

Ability include: knowledge, social support, skills & self efficacy, roles & decisions and

affordability. The key question here is if the individual capable of performing it?

Motivation: The drive, wishes, urges, or desires that influence an individual to perform a

behavior.

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Determinants within motivation include: attitudes and beliefs, values, emotional/physical/social

drivers, competing priorities, intention and willingness to pay. The key question here is does the

individual want to perform it?

( Source: Introducing SaniForm A Framework to analyse Sanitation Behaviors to design

Effective Sanitation Programs, Jacquline Devine, October 2009)

4. Selection of Study Sites

As a qualitative formative research, the number of villages selected is kept relatively small and

purposeful. The study sites were selected from the four Zobas (Debub, NRS, Gash Barka and

Anseba) and they were identified in consultation with MoH/UNICEF. As such, the study gave

special attention to uniqueness of ethnic groups, villages with high OD, exposure to CLTS,

rural/urban and religion and geographical variation has been taken in to consideration.

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5. Methodology and Tools

The Formative Research on cultural and behavioural barriers analysis on Sanitation and Hygiene

in Eritrea adopted the following methodologies and tools, in a logical sequence.

Srl# Methodology Tools

1. Review of existing literatures and documents Documents , publications and reports

2. Working session with partners and core team

to define objectives, study sites, study

population and determinants and framework

for research held and inception report was

drafted and endorsed

Inception report

3. Recruitment and training of field Researchers Three day workshop, on qualitative

research methodology –FGDs, IDI

and KII

4. Focus Group Discussions with village

Men/boys and Women/ girls

FGD guide

5. In-depth Interviews Men and women In-depth guide

6. Key Informants Interviews with programme

managers, community leaders, Hygiene and

sanitation promoters, Facility based health

Semi-structured guide

S/Zone Village Ethnicity

1. Debub Mendefera Adi belay Tigrinya

Adi Keyih Hiero Saho

Dubarwa Gezalamza Tigre 2. NRS Massawa Wedibuae Raishaida

Massawa Emberemi Tigre

Foro Kadra Saho

Gelalo Gafano Afar 3. Gash Barkha Barentu Ashoshi

Kunama

Gogne Gogne

Nara

Fort Sawa Senket-Kinab

Hidarb

4 Anseba Hagaz Seberbejuk Bilen

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workers, Zonal school health focal person

7. Analysis

6. Literature/Documents Review

A number of available literatures and documents related to Sanitation and Hygiene in Africa and

Asia were reviewed. Communication strategy (2013-2016), Eritrea Country Office Strategic

Moment of Reflection 2014, Strategy Paper, Sector; WASH, KABP Study and the overall

framework designed by the technical working group, Situation Assessment Report,

Focus Group Discussion (FGD)

FGDs were conducted with homogenous groups of village men and women separately using a

FGD guide to explore issues related to the key cultural and behavioral questions centered around

the OAM determinants. Small homogeneous groups consisting of 6-12 people belonging to the

intended group were considered as a focus group. The discussions took about 1 ½ hours to 2

hours to complete each group. A total of 24 focus groups with participation from a total of 188

participants (95 Men and 93 women) were organized as shown below. With the support of

Environment health division of each Sub Zoba and the village administrator assisted in the

identification and recruitment of the intended participants.

FGDs Conducted Regions S/Zone Village Ethnicity FGDs Men FGD

Women

Total

1. Debub Mendefera Adi belay Tigrinya 1 (8) 1 (8) 16

Adi Keyih Hiero Saho 1 (6) 1 (7) 13

Dubarwa Gezalamza Tigrinya 1(8) 1 (8) 16 2. NRS

Massawa Wedibuae Raishaida 1(12) 1(8) 20

Massawa Emberemi Tigre 1(12) 1(13) 25

Foro Kadra Saho 1 (8) 1(7) 15

Gelalo Gafano Afar 1(8) 1(7) 15 3. Gash

Barka

Barentu Ashoshi

Kunama 1(6) 1(10) 16

Gogne Gogne

Nara 1(6) 1 (7) 13

Fort Sawa Senket-

Kinab

Hidarb 1 (10) 1(7) 17

Anseba

Hagaz Seberbejuk Bilen 1(11) 1(12) 23

Total 11 9 12 12 189 (Number in parentheses denotes the number of FGD discussants)

.

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In depth interviews

An in-depth interview is a qualitative research technique that allows an interviewer and the

respondent to discuss confidential and secure conversation on an issue in focus such as sanitation

behaviors or gender considerations. It can lead to increased insight into people's thoughts,

feelings, and behavior on important issues affecting them. A total of 33 in-depth interviews (18

Men and 15 Women) were conducted with various categories of village men and women who are

not involved in the FGDs. An open-ended guide will be developed for in depth interviews and

will be used to collect responses pertaining to focus cultural and behavioural barriers for

Sanitation and Hygiene in their respective community. Interviews will last 45-60 minutes. Field

researchers will make notes of the discussions.

In-depth Interviews Conducted Zoba S/Zone Village Ethnicity IDI Men IDI Women Total

1. Debub Mendefera Adi belay Tigrinya 1 - 1

Adi Keyih Hiero Saho 2 2 4

Dubarwa Gezalamza Tigre 1 - 1 2. NRS

Massawa Wedibuae Raishaida 1 1 2

Massawa Emberemi Tigre 2 1 3

Foro Kadra Saho 2 1 3

Gelalo Gafano Afar 1 2 3 3. Gash

Barka

Barentu Ashoshi Kunama 2 2 4

Gogne Gogne Nara 2 2 4

Fort Sawa Senket-

Kinab

Hidarb 2 2 4

Anseba

Hagaz Seberbejuk Bilen 2 2 4

Total 18 15 33

Key Informant Interviews

A total 14 of Key Informant Interviews were conducted in the four Zobas with various

categories of people, who were considered as key informants on the basis of their special

expertise or knowledge on the issue related to cultural and behavioural barriers pertaining to

hygiene and sanitation in their respective community (Sschool health focal persons,

Environment Health programme managers, religious leaders, community leaders, community

based health care workers, Hygiene and sanitation promoter). A semi-structured key informant

interview checklist was used to and interviews lasted 45-60 minutes. It may be noted here that

although 18 KII were planned to be conducted, only 14 KII were interviewed due to time

constraints and difficulty to get appointment with other KII.

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Key Informant Interviews Conducted Zoba S/Zone Village Ethnicity Total

1. Debub Mendefera Adi belay Tigrinya 8

Adi Keyih Hiero Saho

Dubarwa Gezalamza Tigre 2. NRS

Massawa Wedibuae Raishaida 3

Massawa Emberemi Tigre

Foro Kadra Saho

Gelalo Gafano Afar 3. Gash

Barka

Barentu Ashoshi Kunama

Barentu Gogne Nara 3

Fort Sawa Senket-

Kinab

Hidarb

Anseba

Hagaz Seberbejuk Bilen

Total 14

7. Data Collection, Transcriptions, Summarization and Analysis

Based on the research methods, tools and respondents as contained in the protocol, the data

collection for the formative research was undertaken by 8 enumerators, led by a team leader. A

three day training workshop was held in Asmara were the team leader gave an overview of

formative research, introduction on SaniFOAM, also training mainly focused on and the

development of the research questions/hypotheses, the team was also trained for one full day on

the range of “in-the-field” skills the methodologies and a detailed study of all the data collection

tools (FGD guide, KII checklist, IDI checklist) which were finalized in Asmara.

With 8 data collectors in all, data collection work took 11 days to complete. The modality of the

field operation was that the data collectors team comprising of 8 members following practical

local logistical considerations, the team first proceeded to Debub, followed by Northern Red sea

(NRS) and then finally to Gash Barka and Anseba. Translators were used when required with

certain ethnic groups.

The data processing mainly followed manual transcriptions, collation, summarization and

analysis in line with the objectives of the formative research. The team leader analysed the

findings using immersion i.e. repeated reading, to identify emerging themes, and by coding

themes arising out of the objectives and triangulation using NVivo. Quotes were extracted to

illustrate the themes.

All paper records of data, including personal identifiers and consent forms will be left with

MoH/UNICEF.

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8. Limitation of the Study

As with every assignment of this nature, there are a number of limitations. Following are some of

them:

A purposefully selected sample is not representative and study findings cannot be

generalized to the entire population.

As the payment of DSA for the data collectors was not cleared before the data collection

period began, this lead to lot of dissatisfaction amongst the data collectors, and it affected

the total number of the days of data collection.

Limited time for data collection.

o The Review workshop of IEC materials were held in all three Zoba and was

incorporated as a part of the data collection process, this reduced the number of

days allocated for data collection.

Market days in certain Zobas posed a constraint to recruit respondents for FDGs and IDIs

and it was found difficult to recruit key informant due to time constraint.

In some Zobas translators had to be used for conducting interviews, this made the

interviewing process longer.

The qualitative methodology used for this study requires lot of probing and then

expanding the field notes and having moderators with training and skills to manage group

interactions. The study were new to qualitative research methodology and lacked

experience

.

Team leader did not obtain the travel permit for Gash Barka, therefore could not

supervise the field work in this Zoba. Even though, WASH Specialist from UNICEF had

the permit to travel to Gash Barka & Anseba it was not possible to travel, due to fuel

shortage.

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9. Findings of Barriers analysis

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9.1Tigrinya Ethnic Group

Background

The majority of the Tigrinya inhabit the highlands of Eritrea.

They are the largest ethnic group in the country, constituting

about 55% of the population2. Their language is called Tigrinya.

Most of the Tigrinya are Christians.

Their way of life evokes images of Bible times. Camels,

donkeys, and sheep are everywhere. Fields are plowed using

oxen. The Orthodox Church is a central part of the culture for the

large majority. The church buildings are constructed on hills.

Major celebrations during the year are held around the church,

where people gather from villages all around to sing, play games,

and observe the unique mass of the church, which includes a

procession through the church grounds and environs.

Coffee is a very important ceremonial drink. The "coffee ceremony" is common to the Tigrians

and the Amhara. Beans are roasted on the spot, ground and served thick and rich in tiny ceramic

cups with no handles. When the beans are roasted to smoking, they are passed around the table,

where the smoke becomes a blessing on the diners. The highlands receive most of their rainfall

during the summer months, much of which goes into tributaries of the Nile, 85% of whose water

comes from Ethiopia. The soil has been depleted by many centuries of cultivation, and water is

scarce. Using thousand year old methods, farmers plow their fields with oxen, sow seeds and

harvest by hand.

The harvest is threshed by the feet of animals. In the home, women use wood or the dried dung

of farm animals for cooking. Women often work from 12 to 16 hours daily doing domestic duties

in addition to cultivating the fields.

Each family—some with eight or more children—must provide all of its own food. Typically,

women perform all work necessary to prepare the meals from grinding the grain to roasting the

coffee beans. Children carry water in clay pots or jerry cans on their backs. Marriages are

monogamous and arranged by contract, involving a dowry given by the bride's family to the

couple.

The new couple spends some time in each family's household, before establishing their own

home at a location of their choice. Inheritance follows both family lines. Inheritance is

determined following a funeral commemoration a year after the death, which may consume most

of the deceased's estate.

The country houses are built mostly from rock, dirt, and a few timber poles. The houses blend in

easily with the natural surroundings. For many families, the nearest water source is more than a

2 World fact Book: Retrieved M

https://en.wikipedia.org/wiki/Tigrinya_language

https://en.wikipedia.org/wiki/Nile

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kilometer away from their house. In addition, they must search for fire fuel throughout the

surrounding area.

The Tigray-Tigrinya have a rich heritage of music and dance, using drums and stringed

instruments tuned to a pentatonic scale. Arts and crafts and secular music are performed by

mostly pariah artisan castes. Sacred music and iconic art is performed by monastically trained

men3

The findings presented below are from those interviewed in the Debub Zoba in the Mendefera

sub zone in the village of Adi belay.

Water Handling & Use

The community uses unsafe water source, there is only two villages from the twenty villages of

catchment area that has safe water source. As a result, this health facility stands first in the Zoba

for the ten top diseases among which is bloody diarrhoea is one of them. The main barrier behind

this is;

- Water source is same where their animals drink,

- Sewage system of the health facility is also drained through the village giving bad odor

and discomfort and bloody diarrhea. Due to this issue, the government has now made

fenced well, but this still poses other barriers like;

- Scarcity of water,

- Distance from the fenced well,

- Long que,

- Community still uses water from unprotected streams

- The majority believe that boiling water does nothing. In this community it is said that

“eta may may eya feliha Entary rishat Awtsia ilom yimigutu” which means when you boil

the water there is no dirt removed that you can see.

- Besides, there is shortage of fuel to boil water. Water treatment remains questionable.

- Community has water problems, but they still believe that water can not harm and is

considered holy”mai abesayeblun”and if it is a dug up water it is considered clean, but if

it is from streams community believes it can be contaminated.

- Women and children carry water on donkeys using Jirbas and jericans to transport it to

homes and then poured into a bigger Bermil.

- So most community members use it as it is, but there is also practice of “sheb”use which

is aluminum sulphate to treat water.

- The community is aware that contaminated water can cause diseases like schistosomiasis,

giardiasis, diarrhea, abdominal cram and vomiting.

Saying: “Clean as morning water to explain honesty of someone”. “The one who gave us water

appreciated the purity from turbidity”.

3 https://en.wikipedia.org/wiki/Tigray-Tigrinya_people#History

https://en.wikipedia.org/wiki/Pentatonic_scale

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Latrine Coverage & Use

Target Group: Men and women without latrines

Behavioral Question: Why rural householders (men, women) defecate in the open?

Opportunity Ability Motivation Access/Availability

• Have no access to

latrines

• Limited access to

skilled labor

• Not affordable to

construct latrines as

stone, cement and iron

bar expensive

• Difficult to transport

no camels ,

• Rocky region

Product Attributes

• Preference is high for

stone as wood latrine

can be destroyed by

termites

• Cost for pour stone

latrine is considered

high

• Low preference for pit

latrine for its qualities

(bad smell, not user

friendly with the

old/elderly and

children, attracts

more flies

Knowledge

• Lack of knowledge

about how latrines can

prevent diseases

Social Support • No support from govt,

admin suggested to

make latrines of wood

but community

prefers brick afraid of

termites

Skills and Self-efficacy

• Community not

confident about

building simple pit

latrines due to

skills reasons

Beliefs and Attitudes

• Culturally

unacceptable &

shameful to defecate

in bare fields “chiwa

hzbi”

• Smelly, harmful don’t

it want near the house

• Belief that waste

should be kept outside

• Strong belief that

whenever someone

cleans his/her anus

with hot stone can get

hemorrhoid disease &

infection

• Belief that if some

defecates in garbage

he/she can be possess

d evil spirit

• Cultural belief by

forefathers that if you

go to latrine at noon

or mid-night you

could possessed by

evil spirit.

• Belief bride can be

possessed a pit latrine

made. After

honeymoon goes

back to OD.

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Opportunity Ability Motivation Social/cultural norm

• Habituated with the

practice of OD difficult

to give up old traditional

habits

Sanctions/Enforcement

• No rules/policies

enforced on open

defecation in the

villages

Knowledge knowledge about the process

of how latrine use can help

prevent diseases is limited for

the men and completely

unknown for the women


• Cultural belief by

forefathers that if you

go to latrine at noon

or mid-night you

could possessed by

evil spirit.

• Belief bride can be

possessed a pit latrine

made especially for

her. After honeymoon

she goes back to

OD.

Values

• People confer low

value to latrine

construction

Summary of Findings Opportunity

Access/Availability: The practice of open defecation is due to a number of behavioral factors.

Moreover, there is a prevailing notion that it is difficult to buy the necessary sanitary products

and materials such as stone cement, iron fittings from the distant market. The non availability of

easy and reliable transportation for materials from the market to the villages is another concern.

In some villages there is shortage of stone and they bring it using camel/donkey from far places

Product Attributes: The people in general dislike the existing pit latrines for a number of

attributes. They said that it emits bad smell, is infested attracts a lot of flies. Not user friendly

with elderly and children. Preference for stone Latrines as wood is eaten by termites. However,

stone latrines are considered expensive.

Social Norms: Deeply habituated with the age old traditional practice of going to the bush that

they find quite comfortable to continue with it.

Sanctions/Enforcement: There are no formal policies or rules enforced on sanitation or open

defecation in the villages. There is an informal unwritten “fear appeal” rule of levying a fine

(monetary) to those who do not build and use a latrine for defecation.

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Ability. While there is general awareness out diarrhoea and dysentery as the most common

water and sanitation related diseases, knowledge about the process of how latrine use can help

prevent these diseases is limited for the men and completely unknown for the women. Only a

few men could recall about how flies and fluid can be a route of disease transmission but no

recall of feces as the root route of disease transmission in any way and how latrine can break the

transmission.

Social Support: Government has asked the community to build wooden latrines but people

prefer stone latrine as they are afraid of latrine collapsing due due termites.

Skills, self-efficacy: The community as reported that they have inadequate skills to build latrines.

Motivation

Attitudes & Beliefs: There are a lot of beliefs and attitudes related to sanitation and open

defecation in particular in the community. One of the most common belief discouraging open

defecation emanates from the age-old social and cultural beliefs that by forefathers that if you go

to latrine at noon or mid-night you could possessed by evil spirit. Smelly, harmful don’t it want

near the house Belief that waste should be kept outside. Strong belief that whenever someone

cleans his/her anus with hot stone can get hemorrhoid disease & infection. Culturally

unacceptable & shameful to defecate in bare fields “chiwa hzbi”. Belief that if some defecates in

garbage he/she can be possessed evil spirit.

Value

Community Confers low value to latrine construction

Handwashing and Face washing

- In Trigniya community it is a culture that mothers take care of children concerning their

sanitation and hygiene activities.

- Some mothers clean the children’s bottom, they are unaware about consequences of

handling infant feces. Hence, they simply wash their hands merely with water. They

believe that

as far as the infant has not started eating food (he/she is on breast feed) his feces can’t

cause any diseases.

- Children wash hands of elders out of respect and in return children are blessed by their

elders, but the children do not wash their hands when they eat food with their families.

Hand washing is practiced while preparing food and when eating.

- But in ceremonial gatherings hands are not washed for instance when are about to serve

traditional drink “siwa”.

- In ceremonial gathering people wash their hands before eating. Before they are served

they wash their hands by only water and after the meal they use soap.

- It is believed that when people wash their body and go outside they can be catch cold.

This means in Tigrigna “kuri twesid”.

- .The community is aware that dirty hands can cause diseases like amoeba giardia,

abdominal cram diarrhea, amoeba, pinworm, vomiting etc.

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Food Hygiene

Since most of this community are farmers they keep their food clean and they do not have left

over foods. There is a belief in the community that food is blessed. They believe that food causes

less or no harm to human health. To preserve the food from contamination they prepare fresh

food daily and cover their food. Leftover food are heated well. If they think that it is

contaminated it is thrown. When the leftover food is hot it is given to children. Ingera can be

stored for three days but if it kept for more than that it should be thrown away. Food is saved in

Gibabo (tradition food storage material) in the village. Left over of food is given to children

during ceremonial events as they are not allowed to attend.

Environment Cleanliness

- Some members of the community use domestic garbage is as fertilizers.

- There is no community cleaning campaign. Individuals clean their compounds by

themselves.

- It is believed if some one goes to garbage where (blood of cattle and abdominal parts of

cow have been slaughtered) he can be possessed by evil spirit.

Sayings: they insult people “garbage” so the community appreciate cleanness.

- The house hold wastes are collected in a container and it is thrown far away from the

house. These animal wastes at summer time smell and can cause malaria.

- If the animal waste at summer time is decomposed and mixed with water it creates semi

liquid solution and harbors flies which can cause diseases.

- There is a belief in by this community that a person could be possessed by evil spirit

when they sweep their home at noon time and at night. Possession by evil spirit can more

likely happen if the disposed waste (Goduf in Tigrinya) contains more ashes.

- They believe that going across the village damp places has evil spirit and they don’t

dispose their wastes during sunny day or they don’t dispose go alone to that place.

The channel of communication preferred by community

- Continuous community mobilization

- During social events messages should be disseminated by health facility experts

20

Messages to Address Barriers

MESSAGES

Identified

Barriers

Support messages to be explained Benefits Call for action messages to

address barriers

1 Water handling and use Draws water from

the unsafe water

source available

-Safe sources of safe water include piped

water and water from protected wells, wells

with hand pumps, engine-pumped wells and

protected springs.

-Unsafe water sources include water from

streams, ponds, unprotected wells, and

water delivered by trucks, donkeys or other

animal pulled carriages

Water from safe sources is clean

and has no germs that can make

you and your family healthy

Water from unsafe sources has

germs which can make you and

your family sick

-If you have to draw water from

unsafe sources, make it clean and

safe before drinking

-Boiling water does make water

Share same water

source with

animals and for

washing clothes

and utensils

Fence around the water source to keep

away animals and children

Separate areas for drawing water, watering

animals, washing clothes and utensils and

bathing

Protected water sources are clean

and have clean water

Drinking clean water from

protected wells makes you and

your family healthy and strong

Work with the village

administration to mobilize the

community to protect water

sources

Use traditional

storage and

treatment to keep

water clean

Unsafe water can cause disease Clean water makes you and your

family healthy

Water with germs will make you

and your family sick

Draw and store water in a clean,

covered container

Wash your hands before you draw

water

Use a clean container to draw

water from the storage container

21

2 Latrine coverage and use Support messages explained Benefits Call for action messages to

address barriers

People prefer to

defecate in open

fields and bushes,

Lack knowledge

about benefits of

using latrine

-When you defecate in the bush, storm

water carries your faeces into the wells and

rivers and people and children who drink

from these water sources drink some of

your faeces and get sick with diarrhea and

other diseases

-Allows you to defecate in privacy

-Keeps your compound and the

village clean and free of faeces and

smell

-Saves you the long journey to the

bush

-Saves you the shame of having to

look for a place to hide in the bush

-It ensures that your water sources

are not contaminated

-It perverts diseases such as

diarrhea and other diseases

-Defecating is natural and it is not

a shame to be seem going into a

latrine

-Train your child to defecate in a

potty or a piece of paper or cloth

-Throw the faces of your child in

the latrine

-At the age of 5-7 years train your

child to use the latrine

Afraid of wood

latrines

collapsing, prefer

stone latrines,

rocky soil,

transportation

problem to get

material

-. Seek advice and support from you Village

Health Committee or Village Administrator

on how to dig and construct your latrine

-A latrine makes your home free of

faeces, clean and free of smell

-More and more Eritreans are

building their own latrines and

saying No to open defecation.

Do not be left behind; build your

own latrine

Dig a latrine 2.5-3 meters deep.

This should last an average family

more than 10 years

A latrine can be built in any soil.

People have built latrines in the

rocky soft and sandy soils of

Eritrea

Believe that

latrine smell and

are not clean and

full of flies

-Sweep your latrine regularly, at least once

per day

Will be free of smell and flies

A clean latrine is free of smell and

flies, and is comfortable to use

Identified

barriers

Support Messages to be explained Benefits (Why) Call for action messages

address barriers

22

3 Personal hygiene and hand washing

Wash hands with

water only

Babies who has

not started eating

their feaces is

considered

harmless

Wash your hands under running water

Washing without soap does not remove all

the dirt and germs

When you wash without soap, your hands

remain with some of the dirt and germs.

And handling food with dirt in your hands

can make you and your family sick

Washing hands with water and

soap removes dirt and germs

leaving the hands clean and fresh

Clean hands help us to avoid

diseases and remain healthy

. Wash your hands with water and

soap:

-After cleaning up the baby who

has defecated, Infants and children

feces can cause disease like adults,

-Before handling or preparing food

-Before eating

-Before breastfeeding or feeding

your baby

Avoid washing hands in water that

has been used by somebody else.

It is believed

that when

people wash

their body and

go outside, they

can be catch

cold. This

means in

Tigrigna “kuri

twesid”

The more frequently you bathe, the better

for your skin and your health

Children urinate, defecate and play in dirty

places handling dirty objects and get dirtier

than adults. They need to be bathed more

frequently to remove the dirt and remain

fresh

Bathing:

Removes dirt and germs from your

skin and the skin of your baby

Opens the pores to allow the skin

to breath and become healthy and

shiny

Removes bad odor

Makes you feel relaxed and fresh

Cools your body in hot weather

Enhances your overall health

Bath with water and soap as often

as possible

-If possible daily

Bathe your child with water and

soap at least once a day

Train older children to bath with

water and soap as often as

possible, if possible daily

Use warm water if the weather is

too cold

If you cannot find enough water,

mop the parts tht sweat (such as

private parts and armpits) with

water and soap to remove bad odor

and feel fresh

4 Cleanliness of the home environment

Throw garbage in

the river or gorge

Sweep your yard and collect garbage

around the compound regularly

A clean compound:

Get a container in which to throw

garbage

23

Is tidy and attractive to look at and

sit and lie on Is safe and has no

objects that can hurt people or

children

Empty the container when it is full

and throw garbage in the garbage

hole

When the garbage hole is full bury

and make a new hole or burn to

create more space

Join other and community

members to collect garbage and

keep your school, your home and

your village clean

Defecate in the

latrine always

See under latrine coverage and use above

See above See above

24

9.2 Tigre Ethnic Group

Background

The Tigre are traditionally nomadic shepherds who occupy only

part of the north Eastern Eritrea. They are hereditary slaves, which

makes them different from other ethnic groups. The Tigre have

physical features that resemble the Egyptians and majority of them

are Muslims. They believe in an evil spirit called Zar who

possesses people and cause accidents and even death. They do not

believe in hospitals but rely on Shamans, who are the priests, for

treatment. The Shamans also control events and communicate with

the spirits4.

Water Handling and Use

The source of water for this community is from pipe and unprotected well and

unprotected stream which they consider holy surrounding St. Eiwostatios. The men and

boys fetch water. They have been using that water for decades now, though it is recently fenced the water

still not clear. So they treat the water by filtering it using a fine thread clothing and at

times most of us boil it. Some of them also use “sheb” which is Aluminum Sulphite in

order to help settle the turbid particles. Some community members also use lemon and

ashes to kill the worms.

The water has some visible microorganisms and it is hard water. At the time of hard ship

times they also drink water from streams.

Traditionally they treat their water at home by filtrating it and boil it if their children

wants to drink.

In field some of men drink water from motor well without being aware of its cleanliness;

and they believe that it cannot cause disease. This is done as a last option of to drink

instead of being thirsty. In field it was stated that at times they used to even drink their

urine, so why not to drink any water of God like “Hariet” in Tigrigna.

Lack of knowledge about water borne diseases is higher among men.

Community is aware that contaminated water can cause a disease like diarrhoea

abdominal cram jardias and kidney problems

4 : Eritrea24 Date: March 2, 2012 - Category: Culture

25

Latrine Coverage and Use

Opportunity Opportunity Motivation

Access/Availability

ODF village has latrines

Product Attributes

sandy soil, termites, and lack

of wood

Social norms Some still defecate in open

Sanctions/enforcement Internal community laws

(Sanction) which punishes

people practicing OD

Social norm Some still prefer defecate in

an open areas

Knowledge

Community understands that

open defecation can cause

disease such as diarrhoea,

abdominal cram. They get

this information from the

health workers.

Affordability Some could not build due

financial human constraints.

Have to pay 1000 Nafks to

laborer to dig a pit

Skills Community has inadequate

skills to build latrines

Beliefs/Attitudes

• Defecating during

sunny time in the

latrine and whenever

there is hot things

comes from latrine,

the person can get

haemorrhoids. To

avoid this type of

disease they pour used

motor oils ‘Olio

bershahto’ and ashes

and to avoid terrible

smell.

• Embarrassed,

ashamed when

someone see them

while defecating in

the open

• Latrine is smelly, but

outside it does not

smell since, the

weather is hot their

area it can add up

additional heat while

sitting and defecating

inside a latrine.

• Taboo to be seen

defecating by opposite

sex or family

members

• Latrines get dirty,

smells

Emotional/social drivers fear of scorpion, snakes, and

sliding to the pit

26

Handwashing

• Religion excepts this community to be clean, so hands are washed before eating

and after defecating

• It is also known that for the adults they have to wash hands five times (during pray)

with water only.

• They consider adult faeces is more harmful than the child because a child only has

milk does not eat foods.

• In this community children defecate in the compound home.


• They do not sweep their compound in night because they believe that the grace will

be taken away from the home also fairies will slap. Wastes collected is taken to the

other corner of the village and expected that the rainfall will take it with the flood.

• Wastes are food particles, sachets, and other dirt materials.

Channel of communication

The channel of communication preferred is through administration, community leaders, radio

and Television

27


MESSAGES

Identified

Barriers

Support messages to be explained Benefits Call for action messages to

address barriers


the unsafe water

source available




protected springs.










your family sick





Share same water

source with

animals and for

washing clothes

and utensils





bathing









sources

Use traditional

storage and

treatment to keep

water clean


family healthy




covered container


water



28

2 Latrine coverage and use Support messages Benefits Call for action messages to

address barriers

It is a ODF

village, however,

some still prefer

to defecate in

open fields and

bushes






other diseases

--Keeps your compound and the


smell


bush







- Use your latrines, allows you to

defecate in privacy




the latrine



Afraid of sandy

soil, termites,

and latrine

collapsing

- Seek advice and support from you Village




feces, clean and free of smell



more than 10 years




Eritrea

Believe that

latrine smells, its

when its sunny

hot things comes

out giving

haemorrhoids

which gives and

are not clean and

full of flies


per day




29

Identified

barriers

Support Messages Explained Benefits (Why) Call for action messages

address barriers


Wash hands with

water only

Consider babies

who has not

started eating

their feces is

harmless

Children defecate

in the compound



the dirt and germs











soap:





-Before eating


your baby



Even though

religion tells

them to wash

hands

frequently the

hand washing

message should

be re enforced







fresh

Bathing:





shiny

Removes bad odor





as possible

-If possible daily







too cold





and feel fresh

30


Throw garbage in

the river or gorge



A clean compound:




children


garbage



hole



create more space




your village clean

Defecate in the

latrine always


See above See above

31

9.3 Saho Ethnic Group

Background

The Saho mostly reside in Foro, which is a few minutes’ drive from

Massawa, there also some Saho community living in Adi Keyih. With

good roads and organized families, this community practices farming

from where they get their food and money. A small village like Foro has

more than 200 homes with well-built houses and clean environment

because they believe in community work.


In Adi Keyih the water source is from a fenced dug up well, this

community gets water from the river streams and even animals use this source for drinking and

people wash their clothing and their body in the streams as well.

- Water is treated by using fine threads clothing before its poured into Jericans. This

method is not used by most in the community.

- Community believes that contaminated water can cause disease like diarrhea, kidney

stone, giardia and abdominal cramp. However, children don’t have the knowledge and

drink water from anywhere.

- Community believes that diseases can be transported if the containers are not clean, they

can contaminate the water when pouring it in.

- Before they used to wash water containers with (Hamobohambo) sand and leaf. Now

containers are washed lili and water, but when one can’t find lili its washed with water

only. - The water source of the community is from closed water source they don’t belief that

their water source is safe. The water is very hard that causes diarrhea to the community

members. They relate the diarrhea to the water from their experience. Most of the

participants agree that whenever they drink water after few minutes they get diarrhea. As

a result they bring water from nearby village which is 3-5 kilometers away. Additional

source is streams particularly during rainy seasons. Water from the streams and well treat

it by settling and filtering with piece of cloth or gauze

- Aware that contaminated water can causes diseases and treat is water by boiling though it

is not cost effective and unaffordable to provide all family members by boiling.

- Religiously it is taboo (memnue from the Quran) to defecate around streams and shade of

tree. Its believed that a person can get sick if he/she defecates under a tree as it’s a a place

where people take rest.

- It is believed that everybody is obliged to keep water clean. Unless the water is not kept

clean one cannot practice religious prayers or selat. The community has a good saying

that promote good water handling that is “if you water is bad your food would be

bad”.(kolatmonoko qushitome in saho language) and they added “water is life”.

32

Latrine coverage and Use


Access/Availability

• Barrier to the

community in

construction the

latrine is constructing

materials like cement

and iron bars are in

shortage.

Social Norm

• Even though some

people have latrines,

there are people who

use them and there are

people who do not use

them due history of

OD practice.

• Elderly people still

prefer OD

Sanctions/enforcement Community has a rule

financial punishment 1500

Nafka for everyone who does

not construct latrine.

Fine: 50 Nafka if seen OD,

100 Nafka second time,

Third time no social service

from administration,

If don’t stop sub

administration is informed.

Knowledge

• Good knowledge

about diseases

associated to OD like

diarrhea, vomiting,

worms, cholera,

malaria

• Community built the

latrines without being

sensitized on the

importance of not

defecating in open.

• It’s a difficult to give

sanitation & health

education to nomadic

Saho community.

Skills and Self-efficacy

• Community not

confident about

building simple pit

latrines due to skills

reasons

• Lack of skill in

constructing and

upgrading latrines

Affordability Community cannot always

afford latrines

Beliefs/Attitudes

• Embarrassed,

ashamed if seen OD

by opposite sex

• Cultural belief

whenever someone

goes to latrine during

day will get evil spirit.

• Religious leaders and

holy book dictates not

to defecate in open

it’s a taboo.

• Religion tells that

after defecating one

should wash with

water for anal

cleansing with left

hand

• Discouraged to use

latrines, due to water

shortage during dry

season march-June

• Belief that latrines are

for children and

women

• Additionally taboos

defecating under

edible trees is

forbidden

Handwashing & face washing

Religiously everybody is obliged to preform cleaning after defecation using left hand. If

they have to go the mosque they must wash hands, face and feet also when they are about

to read the Quran. And if there are in contact with blood they must wash their body.

The community practices hand, face and feet washing with soap in the morning. For

defecation separate containers are always hanging outside the latrine for washing with

soap. Women are responsible for washing the face, hands as well as body of children.

33

Children are washed hree times a day proceeding the cleaning of our selves. Hands are

washed with soap if no soap is available they wash with water only.

Women or girls having their menstrual periods (Frdi) do not wash their body or change

their cloths until the period stops. They wash their hands and face only. This practice is

based on the belief that if they wash their body, the period will not stop. Moreover, if

they change their cloths now and then, the cloths would be stained with blood. A

menstruating mother or girl also does not pray.

A father can wash his children but he would not be respected by his friends and relatives.

“It will cost him his dignity and respect in the community”.

Body is washed everyday but if there is scarcity of water every two or three days.


Wastes collected and put in the route of river streams, just so that it can be taken away

from the surrounding

Belief that if someone goes to garbage place at noon will be attacked be evil spirit,

especially, where the camels and cattle slaughtered. They are considered evil spirit is

from ancestors

34


MESSAGES

Identified

Barriers

Support messages Explained Benefits Call for action messages to

address barriers


the unsafe water

source available




protected springs.










your family sick





Share same water

source with

animals and for

washing clothes

and utensils





bathing









sources

Use traditional

storage and

treatment to keep

water clean


family healthy




covered container


water



35


address barriers

It is a ODF

village, however,

some still prefer

to defecate in

open fields and

bushes






other diseases



smell


bush








defecate in privacy




the latrine



Afraid of sandy

soil, termites,

and latrine

collapsing








more than 10 years




Eritrea

Believe that

latrine smells, its

when its sunny

hot things comes

out giving

haemorrhoids

which gives and

are not clean and

full of flies


per day




36

Identified

barriers


address barriers


Wash hands with

water only

Consider babies

who has not

started eating

their feces is

harmless

Children defecate

in the compound



the dirt and germs











soap:





-Before eating


your baby



Even though

religion tells

them to wash

hands

frequently the

hand washing

message should

be re enforced







fresh

Bathing:





shiny

Removes bad odor





as possible

-If possible daily







too cold





and feel fresh

37


Throw garbage in

the river or gorge



A clean compound:




children


garbage



hole



create more space




your village clean

Defecate in the

latrine always


See above See above

38

9.4 Afar Ethnic Group

Background

The Afar people, who are commonly known as the Danakil, believe

that they are descendants of Noah from the Bible. They are found in

the East African countries of Somalia, Djibouti, Ethiopia and Eritrea.

Just like the Tigre, most Afar people are nomads, with milk and meat

being the major components in their diet. Their camps are

surrounded by thorn barricades to offer protection against attacks

from wild animals and enemies at large. The Afar believes in spirits

of the dead. They believe the spirits are powerful enough to solve

any problem they might have; thus they always celebrate the Raben

(Feast of the dead) yearly.

Water handling and Use

• Water source from Gelalo’s water tank, in summer if water tank is not working

well, water is fetched from surface water which is not safe to drink and increases

risk of diarrheal diseases.

• Women and children carry water to home.

• Families having many children are concerned about water contamination as their

children are always playing with water.

• This community prefers the traditional water containers to the modern plastic

containers.

• Wash water storage materials twice per week with omo, water and homemade

brushes in Tigrigna called as “meshemae” when we are fetching water



Access/Availability

Latrine construction materials

like stone and cement and

iron bar expensive

Product Attributes

Latrines made of wood and

the soil is soft and collapse

frequently.

Social norm

Elderly prefer to defecate in

Knowledge Community has knowledge of

OD and diseases related to it.

Skills

community mainly lacks

human and material capacity

Affordability

Most community members


Taboo to defecate

under big tree that can

be used as shade for

humans and animals

In Afar tradition “shit

shouldn’t be kept in

one place” and they

have a perception that

it would be smelly.

latrine is used only for

brides and delivered

mothers and other

39

an open areas.

Sanctions/enforcements

Since CLTS intervention

households have constructed

the latrine to obey the village

laws.

own wood latrines as it’s

within the financial limit

vulnerable groups

scarcity of water for

latrine cleaning

shame and become

embarrassed

especially if seen by

opposite sex

Find it difficult to

defecate in the same

place.

Personal Hygiene

Traditionally in social gatherings hands are washed using water only.

When they clean children after their defecation they wash their hands using water only

Since the community has water shortage, priority is given to children to be washed.

Wash only once a week when there is shortage of water.

Environment

Afar community believes that there are evil spirit is a garbage area. If you go to the garbage area

evil spirit can possesses you and you become mentally ill.

40


MESSAGES

Identified

Barriers


address barriers


the unsafe water

source available




protected springs.










your family sick



safe before drinking for your

family


-Don’t let children play around

unimproved water sources

Share same water

source with

animals and for

washing clothes

and utensils





bathing









sources

Use traditional

storage and

treatment to keep

water clean


family healthy




covered container


water



2 Latrine coverage Support messages Benefits Call for action messages to

41

address barriers

It is a ODF

village, however,

some still prefer

to defecate in

open fields and

bushes. Think

latrine are for

women and

vulnerable people






other diseases



smell


bush








defecate in privacy




the latrine



Afraid of sandy

soil, termites,

and latrine

collapsing








more than 10 years




Eritrea

Believe that

latrine smells, its

when its sunny

hot things comes

out giving

haemorrhoids

which gives and

are not clean and

full of flies


per day




42

Identified

barriers

Support Messages Benefits (Why) Call for action messages

address barriers


Wash hands with

water only

Consider babies

who has not

started eating

their feces is

harmless

Children defecate

in the compound



the dirt and germs











soap:





-Before eating


your baby



Even though

religion tells

them to wash

hands

frequently the

hand washing

message should

be re enforced







fresh

Bathing:





shiny

Removes bad odor





as possible

-If possible daily







too cold





and feel fresh

43


Believe that one

can be possessed

by evil spirit and

get mentally ill



A clean compound:


sit and lie on

Is safe and has no evil spirit or


children




your village clean

Defecate in the

latrine always


See above See above

44

9.5 Rashaida Ethnic Group Background

The Rashaida, who originated from Saudi Arabia, have a living style

similar to the Arabians and most of them are Muslims. The dressing

code for women from a young age involves veils that cover their faces

so that men cannot see them unless the men are their own husbands.


Source is from city municipality truck and, when there is

shortage they get from unprotected deep well (9-12m deep) from

the airport.

They also use water from a river which is not clean, which is not

protected where animals drink from this source.

Most of the time men and boys fetch water from the well using camels and also women

fetch water if they are not married.

Community is aware of the water borne diseases such as diarrhoea, vomiting and

abdominal pain skin itching if a dog salivates in the water.

Traditionally they boil water to make it safe and treat contaminated water by straining,

sedimentation, and adding salt as coagulant and boiling.

The reasons for adding salt is that community believes that salt is a medicine by itself

and can kill microorganisms that cause a disease .



Social norm Tradition to defecate in an

open areas, they believe that

in their tradition “Aedat” they

do not encounter any health

related problems when they

defecate in an open fields.

Affordability

Know that flush latrines are

expensive


• nomadic lifestyle and

they don’t want to

construct temporary

latrines.

• “defecating in latrine

cuts your nose”. i.e it

smells bad

• Strongly mentioned

that they wouldn’t like

to use a toilet after

someone else had

used it as it is dirty

and smelly.

45

• Embarrassed,

ashamed to be seen

by anyone, so go to

far off bushes.

Value Prefer modern flush latrine

instead of a simple pit.

Handwashing

Take bath every Friday as it is related with their religious practice

It’s a sin and unholy to pray without being clean for this occasion

Wash their hands with water alone before eating and use soap for washing their hands

only after eating greasy foods.

Scarcity of water is one barrier main barriers for not washing their hands frequently

46


MESSAGES

Identified

Barriers


address barriers

1 Water handling and use Draw water from

the unsafe water

source available




protected springs.










your family sick



safe before drinking for your

family


-Don’t let children play around

unimproved water sources

Use traditional

storage and

treatment to keep

water clean


family healthy




covered container


water



2 Latrine coverage Support messages Benefits Call for action messages to

address barriers

Nomandic

lifestyle, do not

want to construct

temporary

latrines prefer

open defecation






other diseases



smell


bush

Use latrine it allows you to

defecate in privacy without being

ashamed or embarrassed of being

been by others and in security


47

in the far off

bushes







the latrine



Believe that

latrine smells and

do not want to

use latrine used

by others



Identified

barriers

Support Messages Benefits (Why) Call for action messages

address barriers


Wash hands with

water only



the dirt and germs











soap:





-Before eating


your baby



Even though

religion tells

them to wash

hands




Bathing:




as possible

-If possible daily

48

frequently the

hand washing

message should

be re enforced




fresh



shiny

Removes bad odor










too cold





and feel fresh

49

9.6 Kunama Ethnic Group

Background

The Kunama mainly reside in Gash Barka region in the border villages.

Their language has the same name as the tribe just like the other

communities except the Rashaida who speak Arabic.


Protected and unprotected source

Drill well, open dug well and some fetch water from far rivers if

there is scarcity.

Water tanks /barrels are washed every time they see worms, larvae.

Clean contaminated water with lemon, sand, cloth and mesh. There is also practice in the

community to use small amount of kerosene in their water before they drink it

Belief in the community that water is holy and can do no harm



Access/Availability

Four years back community

was given donation of vent

pipes, some cement for slab

and also a cover for the pit.

Almost everybody has latrine.



Social support Community helps those who

are not able to build their

latrines

Beliefs and Attitudes After defecating they bury the

shit.

Burying shit was done to

avoid evil spirits attack and

not to prevent flies or

diseases.

The barrier is that in open defecation is a traditional practice. People don’t like to defecate at

home they prefer to defecate in the open while they are taking fresh air. They have the belief that

when we construct a latrine there will be flies. From experience the latrines are not properly

constructed as the science demands. Since community are constructing their latrine with local

resource and constructing a latrine is a new practice and skill to the community. As result they

don’t built the latrine as it would be. So the pit of the latrine is not deep enough, hole don’t make

as perfect faeces drops around. These shallow pit and faeces around hole attracts flies. This

practical experience influences their attitude toward latrine construction and use. From

Environmental Health (MoH) there is to shortage of skilled staff there is low follow up in proper

latrine construction.

50

On the other side since a latrine is a new skill in the community they are not forced to build

proper latrine by assuming that with time they can improve it.

Environmental health at Zoba has shortage of qualified and competent to staff to follow the

community. As a consequence to above mentioned staff shortage there is low follow up while

community building their latrines

Handwashing

Community members use indicate shortage of soap as excuse for not using soap. But this

it is related to their behaviour that makes them use water only

In ceremonies and social gathering hands are washed with water only

Due to scarcity of water body is washed twice a week

If someone washes his foot with soap, it is believed he/she will not be .able to walk long

distances.

If he washes his body with soap frequently his skin would become thinner and not

resistant


Community has a belief that when the trenches of cattle clean from their dang there is a fear that

number of cattle will not increase or else their animals will die. If the trench of the cattle is clean

is not good for breading their animal.

51


MESSAGES

Identified

Barriers


address barriers


the unsafe water

source available




protected springs.










your family sick





Share same water

source with

animals and for

washing clothes

and utensils





bathing









sources

Use traditional

storage and

treatment to keep

water clean


family healthy




covered container


water




52

address barriers

It is a ODF

village, however,

some still prefer

to defecate in

open fields and

bushes






other diseases



smell


bush








defecate in privacy




the latrine



Afraid of sandy

soil, termites,

and latrine

collapsing








more than 10 years




Eritrea

Believe that

latrine smells, its

when its sunny

hot things comes

out giving

haemorrhoids

which gives and

are not clean and

full of flies


per day




53

Identified

barriers


address barriers


Wash hands with

water only

Consider babies

who has not

started eating

their feces is

harmless

Children defecate

in the compound



the dirt and germs











soap:





-Before eating


your baby



Even though

religion tells

them to wash

hands

frequently the

hand washing

message should

be re enforced







fresh

Bathing:





shiny

Removes bad odor





as possible

-If possible daily







too cold





and feel fresh

54


Throw garbage in

the river or gorge



A clean compound:




children


garbage



hole



create more space




your village clean

Defecate in the

latrine always


See above See above

55

9.7 Nara Ethnic Group

Background

Unlike most of the other Eritrean Ethnic groups, the Nara depend on

agriculture and farming for their existence. They live in the north of

Gash River, which is in the South Western part of Eritrea. The Nara

men practice polygamy, meaning they are allowed to have as many

wives as one can afford to take care of. Each woman has a separate hut

but will live in the same compound with her co wives. The huts are

round shaped. Many of the people from this community turned to

Islam through forceful conversion. They have mosques that look like

their own huts


Dams, streams, water truck, open dug well, mothers, boys and girls fetch water

Share water source with animals

They suffer from frequent diarrhea

They see worms in water

Consider water holy that cannot harm

Water treated by a traditional tree that has lemon taste, some filter using thread cloth,

sand

Clean water jericans with sand, pieces of plastic and OMO or liquid soap

Latrine coverage and use


Access/Availability

MoH told to build latrines

Unavailability of

constructing material are

expensive

Social norm Tradition and preference to

defecate in an open areas



Social support

Disability a barrier to

construct latrine

Affordability

Some could not build due

financial constraints

Skills

Community has inadequate

skills to build latrines


• Consider latrines

smelly and full of flies

• Ashamed to seen

going to latrine by

neighbourhood.

• Women are more

embarrassment than men

• Dignity in question

• Satan can be found in

bad smelly areas

• Latrines are

considered for women

56

Personal Hygiene

Community also fear that if they wash during their periods it may not stop or become

more so they stay for seven days without washing their body but they can wash their

hands and face.

Environment

They don’t cover the pit. They leave it there until the rain season and washed to the rivers and

streams

57


MESSAGES

Identified

Barriers


address barriers


the unsafe water

source available




protected springs.










your family sick





Share same water

source with

animals and for

washing clothes

and utensils





bathing









sources

Use traditional

storage and

treatment to keep

water clean


family healthy




covered container


water



58


address barriers

It is a ODF

village, however,

some still prefer

to defecate in

open fields and

bushes






other diseases



smell


bush








defecate in privacy




the latrine



Afraid of sandy

soil, termites, and

latrine collapsing








more than 10 years




Eritrea

Believe that

latrine smells, its

when its sunny

hot things comes

out giving

haemorrhoids

which gives and

are not clean and

full of flies


per day




59

Identified

barriers


address barriers


Wash hands with

water only

Consider babies

who has not

started eating

their feces is

harmless

Children defecate

in the compound



the dirt and germs











soap:





-Before eating


your baby



Even though

religion tells

them to wash

hands

frequently the

hand washing

message should

be re enforced







fresh

Bathing:





shiny

Removes bad odor





as possible

-If possible daily







too cold





and feel fresh

60


Throw garbage in

the river or gorge



A clean compound:




children


garbage



hole



create more space




your village clean

Defecate in the

latrine always


See above See above

61

9.8 Hidarb Ethnic Group

Background

The Beja in Eritrea, or Hedareb, constitute under 5% of local residents.

They mainly live along the north-western border with Sudan. Group

members are predominately Muslim and communicate in Hedareb as a

first or second language. The Beja also include the Beni-Amer people,

who have retained their native Beja language alongside.

Water Supply and Use

Drill and tap water which is solar pumped, tap water gets broken they fetch water from

surface water known as “sheyak”. River water is also used.

While transporting water the jerricans make green substance and dust at same time.

Water is treated by using green plant, and put coal to an sometimes cloth

Tap water considered bitter.

They don’t think “sheyak” water to be contaminated

Wash jerricans with small stones to remove green matters and OMO/Lili

When water is stored at home in open lizards, reptiles contaminate water

Hard to reach community no health education has been disseminated here



Access/Availability

No intervention was done

concerning the use and

construction of latrines

Social norm

Tradition and preference to

defecate in an open areas

Knowledge Community has no

knowledge of use latrines

Affordability Some could not build due

financial human constraints.

Have to pay 1000Nafks to

laborer to dig a pit

Skills Community inadequate skills

to build latrines


. Taboo to be seen

defecating by opposite

sex or family

members

• Latrines get dirty,

smells

• When sick of

diarrhoea they put

iron sheet near the

house and then throw

the sheet

• Besides is a taboo to

flatus in front of

others. If anyone does

https://en.wikipedia.org/wiki/Hedareb

https://en.wikipedia.org/wiki/Hedareb_language

https://en.wikipedia.org/wiki/Beni-Amer_people

https://en.wikipedia.org/wiki/Beja_language

62

that he/she is obliged

to leave the village.

• After the person

leaves the community

celebrates his

departure by making a

fist by “saying that

one who crossed the

taboo has abandoned”

• Fear if they just dig a

hole and use it they

might get sick

• family everyone uses

the same latrine the

vulnerable ones like

women and children

• can be possessed by

evil especially if they

use them at noon time

and around midnight

Personal Hygiene

Belief that if a women has her period she doesn’t take a bath because they believe that if

she washes her body her periods will disappear and she will be barren.

The women wash their hair every month when they have to be plaited

In this community if you ask for soap its considered as female behavior

Soap is presented to officials and guests only

Children are not washed frequently, belief that the child can get pneumonia

Mothers don’t wash hand after cleaning their babies bottom

The men don’t wash their body because of pneumonia also

Religiously enforced practice that husband and wife are obliged to wash their body after

having sex.

Environmental Cleanliness

Belief that if women go the waste disposal site during their menstrual time they can be possessed

by evil spirit and they will not conceive. Waste disposed into gorge.

63

9.9 Bilen Ethnic Group

Background

The Bilen in Eritrea are primarily concentrated in the north-central

areas, in and around the city of Keren, and south towards Asmara,

the nation's capital. Many of them entered Eritrea from kush

(central of Sudan) in the 8th century and settled at Merara then

they went to Lalibla and to Lasta finally they returned to Auxum

and battled with the natives, aftermath they returned to their main

base at Merara The Bilen include adherents of both Islam and

Christianity. They speak Bilen as a mother tongue. Christian

adherents are mainly urban and have intermingled with the

Tigrinya who live in the area. Muslim adherents are mainly rural

and have interbred with the adjacent Tigre.

Water Handling & Use

Scarcity of water

Water source Tap water, or big river Ashera which is not Jerricans and barrels are washed

with OMO every 2 weeks

Water is boiled and given to children

Men fetch watch water


Access/Availability

Barriers are mostly obtaining

construction materials

Sanctions/enforcement

Community made regulations

and laws to punish persons

who goes against the law

Social norm

Some elders still practice OD

while having latrine old habit

Knowledge Sensitized about the

usefulness

And importance of using

latrines


Defecating in latrine

considered girlish

Difficult to sit in a

small pit to defecate

Emotional

divers/physical

Comfort

Privacy

No more shame &

embarrassment

Personal Hygiene

• Wash hands with water only not used to soaps

• Wash hair monthly before making plaits

• Belief if women washes her body during menstrual period it creates joint problems.

https://en.wikipedia.org/wiki/Keren,_Eritrea

https://en.wikipedia.org/wiki/Asmara

https://en.wikipedia.org/wiki/Islam

https://en.wikipedia.org/wiki/Christianity

https://en.wikipedia.org/wiki/Bilen_language

64

• Delivering woman doesn’t wash her body for seven days after delivering instead

uses a traditional smoke steam bath

10. Recommendation

• Multi-pronged continuous and coordinated National campaign on Sanitation and

Hygiene through:

Mass media,

Schools ( children as agents of change),

Sustainable awareness campaigns through community leaders, WASH

promotors

Booklet that being developed for sanitation promotors, community

leaders, CBOs must be disturbed across six Zobas

IPC training should be given to sanitation promoters

Regular monitoring should be done regarding the implementation of health

education and campaign programs.


• Replicate the documentation video strategy being used in Debub Zoba to scale up

ODF villages.

• With support of Sanitation Booklet, WASH promoters should be trained on IPC

skills to address the cultural, social norms, beliefs & attitudes amongst the different

ethnic groups

Handwashing

• Enhance the knowledge of the community by focusing on critical hand washing

times with soap;

– After defecation, before handling food and after cleaning children’s

bottom;

• Even though, women are closer and responsible to the house holds hygiene activity,

involving men in hygiene education and activity might improve practice of hygiene

in the community


• More awareness raising campaigns about cleanness of home environment are

needed.

• Having WASH promoters is the best approach in raising the awareness of the

community

• Specific dumping sites must be provided to build a clean environment.

65

• Facilities such as waste containers on dumping sites and trucks that carry filled

waste containers are needed

• Rules and regulation on waste management has to be enforced