June 2004

Sanitation and Hygiene in Kenya:Lessons on What DrivesDemand for Improved Sanitation

This field note summarizes the findings of an assessment on the impact of sanitation technologies inKenyan households and the factors that have influenced demand for the type of technologies usedpresently and in the past. It also seeks lessons for future strategies for achieving sustainable sanitation.

Field Note

The Water and Sanitation Programis an international partnership forimproving water and sanitation sectorpolicies, practices, and capacitiesto serve poor people

Summary

Sanitation and hygiene arefundamental to good health anddignity, and improving sanitation andhygiene practice are householdmatters. However they are oftenstrongly influenced by community‘trends’, and so it is useful to learnabout and compare the perceptionsof hygiene and sanitation athousehold, community and‘official’ levels.

This field note summarizes thefindings of a field assessment onthe impact of sanitationtechnologies in Kenyanhouseholds and the factors thathave influenced demand for thetype of technologies used bothpresently and in the past. Theassessment was conducted by

the Africa region of the Water andSanitation Program (WSP-AF).Historical influences includedecrees by the colonialadministration backed up byenforcement of the Public HealthAct. Today, the demand driversare an understanding of therelationship between goodhealth, hygiene and sanitationpractices combined withdensification which has led to aloss of privacy.

Related issues such as sanitationcoverage, operation andmaintenance (O&M) andexcreta re-use are outlinedas are key issues that haveconstrained the large-scale adoptionof the technologies. Limited financialresources are the major constraintbut the study also identified that a

lack of awareness about sanitationand hygiene, and how to constructand maintain pit latrines, do hindersanitation coverage.

An important aspect of this fieldnote is to seek lessons for futurestrategies for achieving sustainablesanitation. In this regard, progressbeing made in excreta re-use andEcoSan technologies such as theSkyloo, Arborloo and Fossa Alternaare outlined.

Backgroundand ContextKenya’s economy has beenstagnating because of poormanagement and unevencommitment to reform, with a realGDP growth rate of only 1.5% perannum. The per capita GDP isestimated at US$301.

2

Limited financial resources are reported as the major constraint to the large-scale adoption ofsanitation technologies. The study also identified that a lack of awareness about sanitation andhygiene, and how to construct and maintain pit latrines, do hinder sanitation coverage.

The communities selected have different excretadisposal practices some of which are influenced bytraditional beliefs. The Digo in Kwale are mainly Muslimsand their excreta disposal practice is influenced byavailability of water and the belief that people are notsupposed to excrete in houses (including pit latrinestructures). The Kikuyu community believes that animproved excreta disposal facility enhances one’s imagein the society. It is also culturally accepted that if onewants to build a house, one starts by building a latrinefor use by the builders. Nyeri district therefore enjoysthe highest coverage of sanitation facilities in thecountry. The Masai are a pastoral people moving withtheir cattle to find new pastures. They do not buildtoilets, but have been known to use them in the vicinityof watering holes where they temporarily congregate.

Excreta Disposal Practices

Abandoned open air toilet in the Masai area of Kjiado.

The GDP composition by sector isagriculture at 26%, industry at18%, and tourism and otherservices at 56%.

The population of Kenya is projectedto increase dramatically over thenext two-and-half decades, doublingby 2025. Currently official figuresclaim that sanitation coverage islowest in rural areas. The squalor ofinformal settlements is more thanobvious. There is a pressingneed for achieving sustainableand effective sanitationcoverage in Kenya.

Public health, dignity and povertyalleviation concerns, which areheightened by the MillenniumDevelopment Goals on sanitation,are stimulating practitioners torevise their thinking on how toachieve sustained sanitationimprovements for the poor.

Environmentalists are alsochallenging the sanitation sector to‘think ecologically’ to limit thenegative impact of traditionalsolutions, and broaden theoptions of sanitation technologiesto include the re-use ofexcreta nutrients.

This study was sponsored byWSP-AF and forms part of aseries being carried out in anumber of countries includingKenya. The purpose was tocollate information on interventionsand trends that show relativesuccess in improving sanitationand change in hygiene behavior,and how these lessons may

Separate focus groups wereconstituted for women, men, youth,elders and key local leaders fromeach study community. Groupswere led using methods drawnfrom Participatory Hygiene andSanitation Transformation (PHAST)and Participatory RuralAppraisal (PRA).

Existing SanitationExisting SanitationExisting SanitationExisting SanitationExisting SanitationTTTTTechnologiesechnologiesechnologiesechnologiesechnologies

■ The simple pit latrine wasintroduced in Kenya by the colonialadministration and the missionariesmore than 60 years ago. The mainpurpose was to prevent outbreaksof diseases such as cholera andtheir construction was enforcedthrough the chief’s authority.

The pit latrine has been a verysuccessful excreta disposal facility inKenya with about 73% percent ofthe population having access to thisfacility. The locally available materialsused in the construction of pit

3

Sanitation and Hygiene in Kenya

Lessons on What DrivesDemand for Improved Sanitation

inform policy, regulation andstrategy formulation.

Study Areasand Findings

Nine areas were selected for studyin the field. They represented therange of socio-economic andcultural diversity of Kenya in termsof agricultural potential,demographic distribution andculture, including excreta disposalpractices. Areas were also selectedwhere sanitation promotion programshad been active.

Study methods includedhousehold surveys, focus groupdiscussions, interviews with keyinformants and a technicalevaluation of different sanitationtechnologies. A structuredquestionnaire combining bothpre-coded and open-endedquestions was prepared, pre-tested and applied by graduatestudent research assistants.

A simple pit latrine built using locally available materials.

latrines include thatch, iron sheets,sackcloth, mud or any other left-over materials.

■ When VIPs were introducedthey did not seem to expand farfrom the project areas. They arebarely seen anywhere elseexcept in areas where projectassistance provided materials forconstruction. Most project VIPswere abandoned after filling asthey were made of concreteelements that could not bemoved or re-used. They werealso more expensive than thetraditional pit latrines that werealways built with locally availablematerials. As a result the priceof a latrine doubles when ahousehold opts for aconventional VIP five metersdeep instead of a simple pitlatrine of similar depth. Thisexplains why VIP latrines are notmore numerous sincecommunities were unable toreplicate project VIPs even afterinitial material assistance.

The conventional VIP, as promotedby externally supportedprograms, was simply tooexpensive to be adopted byrural communities.

CoverageCoverageCoverageCoverageCoverage

■ The Kenya 1999 population andhousing census showed access tosanitation facilities to be 82%.Coverage data from this study isconsistent with these findings.However, the Ministry of Healthputs the national coverage of

adequate sanitation as below 50%mainly because the Ministryclassification does not consider pitlatrines (on-site sanitation) in urbanareas as adequate.

■ Coverage levels varied from 91%down to 44% in the study areas.According to the 1999 census,nomadic pastoral areas in the NorthEast have access as low as 22%.

■ Some districts registered adecrease in pit latrine coverage andan increase in the use of the bush.These districts lie in flood-proneareas and pit latrines are usuallysubmerged in rainy seasons givinglittle incentive to build new ones.

■ Income levels do not in generalaffect latrine ownership. In bothmale- and female-headedhouseholds the frequency ofownership is remarkably consistentirrespective of income levels, even

among the group classified as‘absolute poor’.

■ Access and ownership are lowerin female-headed households. Thereasons for this are unclear but arepresumed to relate to other genderissues such as constraints onproperty ownership.

■ In the study areas 80% of thehouseholds with access tosanitation, own their pit latrines. Ofthese, 12% were VIPs and the restwere simple pit latrines. Owners ofsimple pit latrines did not get anytechnical or financial assistancewhile 42% of those who own VIPsgot some material assistance(that is, subsidy) in the form offloor slabs, vent pipes and asuperstructure. However, it isinteresting to note that VIP latrineowners in four of the study areaschose this type of latrine even thoughfinancial assistance was not available.

Income levels do not in general affect latrine ownership. In both male- and female-headedhouseholds, the frequency of ownership is remarkably consistent irrespective of income levels,even among the group classified as ‘absolute poor’.

4

An example of a VIP.

Factors thatFactors thatFactors thatFactors thatFactors thatInfluence DemandInfluence DemandInfluence DemandInfluence DemandInfluence Demand

Demand DriversDemand DriversDemand DriversDemand DriversDemand Drivers

The reasons given by respondentsas the main drivers of behaviorchange, and the percentage offocus groups in which they werementioned, are as shown inthe table on this page.

In summary, focus group discussionshighlighted the following items.

In colonial times, householdswere forced by the colonialadministration to dig pit latrinesunder threat of jail, and the PublicHealth Act was enforced throughthe chief’s authority (in terms ofthe Chiefs Act) primarily duringdisease outbreaks. This wasreinforced by missionaries whopreached to their congregations onhow cleanliness (hygiene) was godly.

In modern times, communitiesare better educated and areincreasingly aware of therelationship between good health,hygiene and sanitation practices.The sub-division and ownership ofland have contributed towardsincreased demand for sanitationfacilities because most of theland is now under cultivationand the bush that provided themuch-needed privacy is gettingless and less.

In addition, education motivatedthe youth and men to acquirelatrines more than the othergroups, while prestige wasidentified by youth and women as

5

Sanitation and Hygiene in Kenya

Lessons on What DrivesDemand for Improved Sanitation

an important motivator. Finally,women placed more value on

A poorly constructed pit latrine.

privacy and convenience thandid other groups.

Historical Present Day

Chiefs’ orders during 56% Health and hygiene 86%disease outbreaks awareness and education

Enforcement of 36% Land sub-division, 72%Public Health Act densification and need

for privacy

Influence of the missionaries 28% Prevention of diseases 62%and early settlers

Project assistance 52%

Factors that HinderFactors that HinderFactors that HinderFactors that HinderFactors that HinderSanitation CoverageSanitation CoverageSanitation CoverageSanitation CoverageSanitation Coverage

The main problems that hindersanitation coverage as cited byfocus groups were (in descendingorder of frequency):

1.1.1.1.1. Limited financial abilityLimited financial abilityLimited financial abilityLimited financial abilityLimited financial ability.The inability of a household toraise sufficient funds toconstruct sanitation facilitieswas mentioned in all areas asa hindrance to the constructionof better facilities than thosecurrently used. Financialcapability was mentioned notmerely as a lack of resourcesbut as an opportunity costamidst other competing needs.A household would find it moreuseful to dispatch its ablemembers to pursuits that willlead to the acquisition of otherbasic necessities as opposed toconcentrating their resources(money, time and energy)towards sanitation facilities.Filled up pit latrines are leftto overflow due to lack of fundsto construct new ones.

People mostly learn about sanitation technologies from their neighbors, public health workers,public meetings and community workers.

6

The Poor are Paying for Sanitation

Although all focus groups indicated financial limitations as the main constraint towards achieving coverage,analysis shows that even the absolute poor still manage to afford pit latrines. Excluding the nomadic pastoralistsof Kajiado, a breakdown of latrine ownership shows a surprisingly small range between non-poor (92%), poor(84%) and absolute poor categories (77%).

In addition, 62% of those who already own sanitation facilities were willing to pay to improve them further andmore than 50% of those households without access are reportedly willing to invest in facilities. This stronglysuggests that improvements on coverage and access can be made if the costs are kept low when localmaterials are used and the technology is right.

2.2.2.2.2. Lack of awarLack of awarLack of awarLack of awarLack of awareness of sanitationeness of sanitationeness of sanitationeness of sanitationeness of sanitationand hygiene.and hygiene.and hygiene.and hygiene.and hygiene. The studyshows that there is a positiverelationship between improvements

in education, health and hygieneawareness and the demandfor sanitation facilities. Householdswith members who had a higher

Even the poorest people have built simple pit latrines.

level of literacy were most likelyto demand and adopt safermethods of excreta disposalthan those with low levels of literacy.The higher level of literacy is alsoassociated with a high premiumplaced on health status, whichwill lead to a demand for safersanitation technologies.

3.3.3.3.3. Lack Lack Lack Lack Lack of knowledge on how toof knowledge on how toof knowledge on how toof knowledge on how toof knowledge on how toconstruct and maintain pit latrinesconstruct and maintain pit latrinesconstruct and maintain pit latrinesconstruct and maintain pit latrinesconstruct and maintain pit latrineswithin householdswithin householdswithin householdswithin householdswithin households. This hasresulted in poor quality construction,basic design faults, unsafe pits andpoor maintenance. There is ageneral demand for technologiesthat employ locally and easilyavailable construction materials.

4.4.4.4.4. Adverse geo-hydrAdverse geo-hydrAdverse geo-hydrAdverse geo-hydrAdverse geo-hydrologicalologicalologicalologicalologicalconditions cause a numberconditions cause a numberconditions cause a numberconditions cause a numberconditions cause a numberof prof prof prof prof problems.oblems.oblems.oblems.oblems.

a) Weak soil structure leading tocollapse of latrines especiallyduring the rainy season

b) High water table resulting inshallow pit latrines

c) High basement rock resultingin shallow pits.

5.5.5.5.5. Flooding in low lying arFlooding in low lying arFlooding in low lying arFlooding in low lying arFlooding in low lying areas.eas.eas.eas.eas.Flooding is a major constraint aslatrines fill up and overflow duringthe rainy season.

Quite often the latrines collapsemaking it difficult and expensive torebuild after the rains. In suchcases, family members prefer touse the bush.

6.6.6.6.6. NomadiNomadiNomadiNomadiNomadic pastoralismc pastoralismc pastoralismc pastoralismc pastoralism. This wayof life creates little demand forexcreta disposal facilities because

ExcrExcrExcrExcrExcreta eta eta eta eta Re-use andRe-use andRe-use andRe-use andRe-use andEcoSan EcoSan EcoSan EcoSan EcoSan TTTTTechnologiesechnologiesechnologiesechnologiesechnologies

At the time of the study, in late2002, less than 100 EcoSantoilets had been constructed inKenya but this number hassince increased.

Most households surveyedwere not aware of EcoSantechnologies and theopportunities offered byexcreta re-use especially insoil conditioning for improvedfood production.

However, 70% of the surveyrespondents reported that theyplant foodstuffs such as bananason filled up pits which areconsumed by householdmembers, and 39% of thehouseholds said they werewilling to use excretaas re-usable manurein their farms.

Twenty out of 50 focus groupsinterviewed acknowledged theyhad eaten chickens that fed onhuman waste.

Furthermore, 39% of householdrespondents said theywould be willing to re-usehuman waste as manure intheir farms and 27% wouldapprove their familiesconsuming fish fed on humanwaste nutrients.

All groups admitted to a lack ofknowledge on excreta re-use.

Sanitation and Hygiene in Kenya

Lessons on What DrivesDemand for Improved Sanitation

7

people are always moving with theiranimals in search of new pastures.

7.7.7.7.7. Cultural factorsCultural factorsCultural factorsCultural factorsCultural factors. Variousrespondents mentioned culturalfactors such as restrictions onsharing sanitary facilities betweenadults and children, men andwomen and in-laws, andoutsiders in general. However, thelow priority accorded to this andthe general high level of sanitationcoverage indicate that suchcultural barriers and myths areheld by a minority and arecontinuing to wane.

Strategies for HygieneStrategies for HygieneStrategies for HygieneStrategies for HygieneStrategies for Hygieneand Sanitation Prand Sanitation Prand Sanitation Prand Sanitation Prand Sanitation Promotionomotionomotionomotionomotion

People mostly learn about sanitationtechnologies from their neighbors,public health workers, publicmeetings and community workers.Most respondents believed that thebest channels for the promotion ofhygiene and sanitation are publicmeetings, religious organizations,schools and women groups.

In all areas visited the promotionstrategies mentioned were:

a) Creation of health awarenessand training of community leaders

b) Construction of demonstrationfacilities

c) Provision of construction materials

d) Provision of constructionequipment

e) Enforcement of the Chief’s Actand Public Health Act in the eventof epidemics.

EcoSan Technology

EcoSan technology was first introduced in Kenya inthe late nineties and there are now at least sixprojects in the country run by a number of NGOs.The technologies derive from work done inZimbabwe, Mozambique, Uganda and Ethiopia.To date, the construction costs of most of thesefacilities have been subsidized by NGOs who haveintroduced three types of EcoSan latrines:

a) Skyloo Skyloo Skyloo Skyloo Skyloo(raised latrine with urine diversion and separatecollection of urine and faeces)

b) ArborlooArborlooArborlooArborlooArborloo(with portable superstructure and no urine diversion,a tree can be planted in the filled pit)

c) Fossa AlterFossa AlterFossa AlterFossa AlterFossa Alternanananana(with dual pits and portable superstructure,digested contents of pit not in use can be emptiedafter a year).

Fossa Alterna and Arborloos work best whenquantities of soil, wood ash and leaves areadded periodically to produce a balancedcompost. Skyloos require some ash to dry thefaeces and increase pathogen destruction.

A urine diversion toilet near Mombasa where the jerrycan is usedas a urine container.

SkyloosSkyloosSkyloosSkyloosSkyloos

Several SkylSkylSkylSkylSkyloosoosoosoosoos were built in theKisumu area of the Lake Victoriaregion. The technology was seen asan alternative to the use of pitlatrines in areas where the watertable is high and the communityrelies on shallow wells for their waterneeds. The Skyloo latrine is apermanent feature that requires

8

The study findings show that there is a positive relationship between improvements in education,health and hygiene awareness on the demand for sanitation facilities.

periodic (6-12 months) emptying ofthe receptacle and transportation toa composting site. The communityhas had difficulties adopting theSkyloo type in the pilot area inKisumu. Some of the reasons citedare cultural problems associatedwith urine diversion and handling offaeces. Acceptance is slow andsome latrines in the pilot areahave been abandoned.

Only 8 out of 15 latrines constructedare still in use.

However, some NGOs and aprivate sector manufacturer haverecently reported increasedinterest and a voluntary uptake ofthis technology which isunsubsidized. The interest haspredominated in areas withgeo-hydrological problems.

9

Sanitation and Hygiene in Kenya

Lessons on What DrivesDemand for Improved Sanitation

Fossa AlterFossa AlterFossa AlterFossa AlterFossa Alternanananana

The Fossa AlterFossa AlterFossa AlterFossa AlterFossa Alternanananana toilethas been well receivedin two pilot areas.At least 15 latrines are beingused in schools and publicplaces such as fishlanding sites.

This type does not divert urineand no one needs to handle thefaeces. The maintenance issimple. One needs only tospread wood ash and dry soil

Fabrication of a concrete slab for a Fossa Alterna.

on top of the excreta every timeone uses the latrine. The costsare also less than the cost ofordinary pit latrines.

A demonstration latrineconstructed in a primary schoolhas attracted the interest ofparents who have asked for thedesign so they can construct onein their homesteads.

ArborlooArborlooArborlooArborlooArborloo

One project to introduce theArborlooArborlooArborlooArborlooArborloo latrine has beenreceived with enthusiasm.The initial three demonstrationlatrines have been replicated to57 within the last year. Thehealth and agricultural benefitsare clear to the community.Respondents’ reasons behind

An EcoSan workshop participantdemonstrating the squatting part ofthe urine diversion toilet.

the adoption of the Arborloolatrine include it being affordableand easy to replicate. It useslocally available materials,is easy to construct andmove (even for women), anddoes not need a deep pitwhich is helpful in rockyconditions. Fruit trees canbe grown on abandonedpit sites.

In addition, as Arborloo latrinesare shallow, there is lesslikelihood of ground watercontamination or collapse duringthe rainy season.

Lessons Learned

(1) Historically laws such as theenforcement of the Public HealthAct especially during epidemicsresulted in a significant demandfor latrines.

The main currentmotivation to build latrines isincreased health and hygiene

10

The great majority of households are not aware of EcoSan technologies, although the potentialbenefits in agriculture and hygiene are well understood by the communities that are using them.

An example of an Arborloo.

Agricultural Benefits of Ecological Sanitation

NutrientsNutrientsNutrientsNutrientsNutrientsThe recycling of one person’s faecal and urine nutrients can provide up to85% of the nutrient requirements to grow 250 kilograms of cereals.

ExcrExcrExcrExcrExcreta Re-useeta Re-useeta Re-useeta Re-useeta Re-useExcreta is re-used by applying as soil conditioner on the farm. Fruit treessuch as bananas, avocados, papayas, mangoes can be grown onabandoned pit sites.

Urine Re-useUrine Re-useUrine Re-useUrine Re-useUrine Re-useThe fertilising effect of urine is similar to that of a nitrogen-rich chemicalfertiliser. This means that urine is best utilized to fertilise crops andvegetables which thrive on nitrogen.

awareness, and educationabout disease.

Other factors include densificationleading to loss of privacy, and theoccasional availability ofproject assistance.

(2) Most households that ownlatrines were not provided with anyexternal assistance. Householdsalready spend comparatively largesums of money on sanitationfacilities. Households would prefersanitation technologies that are:

a. Affordable

b. Inexpensive to maintain

c. Clean and hygienic

d. Use locally available materials

e. Easy to replicate

f. Offer safety, privacy, convenience.

(3) Rural sanitation is a matterdecided by the household.Because of cultural norms andconvenience, people do not likesharing latrines.

(4) The majority of households havehad little or no hygiene andsanitation education. This mayexplain why there is poor use oflatrines, and why many latrinesare not safe, do not provideadequate privacy andare unhygienic.

(5) The main problems that hindersanitation coverage as cited byfocus groups were:

a. Limited financial ability

b. Lack of sanitation andhygiene awareness

c. Lack of knowledge on howto build latrines

d. Adverse geo-hydrologicalconditions

e. Flooding in low-lying areas

f. Nomadic pastoralism

g. Cultural barriers, which still exist,but on a limited scale.

(6) Although all focus groupsindicated financial ability as

the main constraint towardsachieving coverage, analysisand observation show thateven the poorest can stillafford pit latrines. More than50% of those not coveredwere also willing to payfor improvements.

11

Sanitation and Hygiene in Kenya

Lessons on What DrivesDemand for Improved Sanitation

This household in Kusa, Kenya has used excreta as manure to grow this tree.

(7) The very great majority ofhouseholds are not aware ofEcoSan technologies, although thepotential benefits in agriculture andhygiene are well understood by thehouseholds that are using them.The limited experience from smallscale EcoSan pilot projects reveals:

Water and Sanitation Program-

Africa

World BankHill Park BuildingUpper Hill RoadPO Box 30577NairobiKenya

Phone: +254 20 322-6306Fax: +254 20 322-6386E-mail: wspaf@worldbank.orgWebsite: www.wsp.org

June 2004

WSP MISSIONTo help the poor gain sustainedaccess to improved water andsanitation services.

WSP FUNDING PARTNERSThe Governments of Australia, Austria,Belgium, Canada, Denmark,Germany, Italy, Japan, Luxembourg,the Netherlands, Norway, Sweden,Switzerland, and the United Kingdom, theUnited Nations Development Programme,and the World Bank.

ACKNOWLEDGMENTSThis field note was prepared by BarryJackson (Adviser, Development Bank ofSouthern Africa). It is based on the report‘Learning from the past and present for thefuture: Sustaining Sanitation and Hygiene inKenya’ by Dr Boro Gathuo, BG Associates(Consultant) for which Dr Pete Kolsky andLukman Salifu (both formerly of WSP-AF)were task managers. The text was reviewedby Dr Pete Kolsky (Sr Water & SanitationSpecialist, WSP), Dr Peter Morgan(Aquamor Limited) and Andreas Knapp(Consultant, WSP-AF).

Photographs: Andreas Knapp andBoro GathuoEdit: Melanie LowPublication support: Vandana Mehra andSarah De Villiers LeachCreated by: Write MediaPrinted at: PS Press Services Pvt Ltd

ABOUT THE SERIES

WSP Field Notes describe and analyze projects and activities in water and sanitationthat provide lessons for sector leaders, administrators, and individuals tackling thewater and sanitation challenges in urban and rural areas. The criteria for selection ofstories included in this series are large-scale impact, demonstrable sustainability,good cost recovery, replicable conditions, and leadership.

a. Within EcoSan technologies aclear preference by ruralcommunities for those withoutdiversion (Arborloo and Fossa Alterna)rather than technologies requiring thediversion of urine (Skyloo);

b. Greater demand for EcoSantechnologies in conditionsof rocky soils and a highwater table.

A community self-help group constructing a urinal at a fish landing site at Lake Victoria, Kenya.

(8) The study shows that there isa positive relationship betweenimprovements in education,health and hygiene awarenesson the demand forsanitation facilities.

(9) Lastly, strategies for promotion ofhygiene and sanitation awarenessshould target self-help groups,women groups, and religious andcommunity leaders.