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Development of a shared latrine cleanliness and maintenance intervention for low-income

urban communities in Dhaka, BangladeshFarzana Yeasmin

Research InvestigatorWASH Research Group

icddr,b

26 October Water and Health Conference

Chapel Hill, North Carolina 2015

Roles of research partners This study is part of a research programme initiated by WSUP

and funded by DFID icddr,b

o Develop and evaluate the behavior change intervention package to improve shared sanitation in Dhaka

o Identify and disseminate lessons relevant for other low income urban settings

WSUPo Identified the research question, and engaged different

stakeholders in urban sanitationo Financially supported the projecto Provided technical feedback on the intervention package

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Background

• Nearly 15 million of Bangladesh’s inhabitants live in Dhaka of whom - approximately six million reside in urban slums and - 4.3 million use communal latrines

• Communal latrines are considered financially and technically viable option in Dhaka’s 5,000 slums

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Background• Improper maintenance of communal latrines,

including safe and timely removal and disposal of fecal sludge, spreads diarrheal pathogens in the surrounding communities

• Proper maintenance of communal latrines is complicated:- Lack of social cohesion- Technical problem- Poor governance

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Objective

To develop and pilot a behavior change intervention that addresses the obstacles affecting communal latrine maintenance in urban Dhaka

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Study sites and duration• Nov 2013 to Dec 2014• Two low-income

communitieso International NGO

piloting toilet improvement interventions

o NGO-trained fecal sludge remover identified problematic toilet blockages

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Study design Phase-1:

Identifying the Barriers to Fecal Sludge Management

Phase-2: Selecting and Pre-Testing the Intervention

Phase-3: Pilot test and assess the acceptability and

feasibility of the intervention package

Phase 1: Identifying the Barriers to Fecal Sludge Management

• Objectives: o To identify obstacles to communal latrine cleanliness

and functionalityo To explore waste disposal practices as they relate to

communal latrine use• Participants: o Fecal sludge removal operators (5)o Adult toilet users (5) proximal to blocked toilets who

are caregivers of children under 2• Methods: In-depth interviews

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Phase 1 Findings• Two important barriers

for communal latrine cleanliness:

- Inappropriate trash

disposal

- Limited/inconsistent water availability

Phase 2: Selecting and Pre-Testing the Intervention• Objectives: o To develop and elicit community feedback on

behavior change communicationso To select waste bin and water storage hardware for

pilot testing• Participants: residents, landlords, and children• Methods: focus group discussions

70L plastic reservoir and 4L flushing bucket

Two types of 12L plastic waste bin

Selected intervention for solid waste disposal and water availability

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Materials to promote behavior change: Proper waste disposal

Do not dispose waste in the latrine Dispose waste into the waste bucket

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Materials to promote behavior change: Cleaning and flushing

We will take a bucket of water from reservoir bucket for flushing

We will clean latrine after defecation by pouring water into the latrine

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Phase 3: Pilot test

• Objective: To assess the acceptability and feasibility of the intervention package

• Participants: Residents of two urban slums

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Phase 3: Pilot test intervention-waste disposal

A. 12-liter bin for waste disposal

B. Signs indicating appropriate waste disposal behaviors

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Phase 3: Pilot test intervention-flushing

A. Signs indicating appropriate flushing behaviors

B. Small, 4-liter bucket for flushing

C. Large water storage reservoir with scoop inside

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Phase 3:Intervention pilot assessment

Spot checks of waste bins & water storage hardware: daily for 2 weeks

Method/Tools Participants N

Indepth Interview

Toilet users 32

Bin cleaners, 6Landlords 6Care givers of children who use potty 4

Focus group discussion

Adult female toilet users 10

Key informant interview

Implementers of project promoting child potty use

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Phase 3 Findings-benefits

• Residents refilled the water reservoir • Designated cleaners to empty waste bins• Reduced toilet blockage and odor

“We would hold a cloth over our nose to use the latrine. Sometimes we fainted in the latrine. After the construction of the latrine it was in this bad condition. Now you have given us materials and the latrine remains much better than before.” (Male resident, water scarcity area)

• Using a potty was easy and more convenient than cleaning up feces from the floor

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Phase 3: Findings-barriers

• Disgust and menstrual management

“Although this bin has a lid, whenever we open it, I feel disgust. This should be a confidential matter as it is an embarrassing matter.” (Male resident, 31 years old)

• Delayed bin emptying by volunteers• Male residents urinate on the latrine floor and

walls creating a bad odor• Children made a mess while defecating

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Addressing barriers• Additional signs for parents and male residents• Latrines remained clean because of these

additional messages

Final intervention hardwareo Waste bin design selected on the basis of most

convenient to maintaino Water storage set with flushing bucket and scoop

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Final Intervention messages

Final intervention activities• Behavior change communication messages delivered by

community health promoters• Interpersonal communication sessions with waste bin

emptiers, landlords and residents• Group meetings with fecal

sludge emptiers• A cue card describing the

benefits of purchasing and using a potty to encourage caregivers

Conclusion

• Community input and iterative intervention piloting identified:o Key audiences o Enabling low-cost hardware and

communication messages o Methods to improve shared toilet

functionality and cleanliness

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Study teamIcddr,b:Leanne UnicombFarzana BegumFosiul NizameMahbub-Ul AlamNotan ChandraDalia YeasminKhubair Hossain Abdullah-Al Masud

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For more information: fyeasmin@icddrb.org

Stanford University:Stephen Luby

WSUP:Guy NormanAnita LaydenAbdus ShaheenHabibur RahmanNasrin Akter

Johns Hopkins University:Peter WinchRonald Saxton

Acknowledgement: Study participants; Diana DiazGranados; Astrid Dier, Dr. Mahbubur Rahman

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