//KHARA HAIS MUNICIPALITY
Basic Household Sanitation
Providing adequate sanitation facilities for the poor is one of South Africa’s major challenges. An estimated eighteen (18) million South Africans are without access to such facilities and may be using the bucket system,pit toilets or the veld. In addition there has been a disturbing increase in the number of poorly designed andpoorly operated water-borne sewerage systems, especially in urban areas.
When sanitation systems fail - or are inadequate - the impacts on the health of the community, on the health of others and on the environment can be extremely serious. This is evidenced in the annual 1.5 million cases of diarrhoea in children under the age of 5 and the recent outbreaks of cholera. In this booklet we attempt to answer most of the questions that communicators will face concerning basic household sanitation.
Most governments struggle with the translation of political jargon into understandable everyday language and White Papers and policy documents raise more questions than answers. In this document we will attempt to answer the most commonly asked questions about the White Paper on Basic Household Sanitation.
Section 1. What is sanitation, and why does it matter?
Q: What do we mean by "sanitation"?
A: Sanitation is any system that promotes sanitary, or healthy, living conditions. It includes systems to
manage waste water, storm water, solid waste, and household refuse and it also includes ensuring that
people have safe drinking water and enough water for washing. Here we focus on the safe management
of human excreta.
Sanitation includes both the ‘software’ of understanding why health problems exist and what steps people
can take to address these problems, and ‘hardware’ such as toilets, sewers and hand-washing facilities.
Together, they combine to break the cycle of diseases that spread when human excreta and waste are not
Q: What do we mean by "good sanitation"?
A: Good sanitation refers to the appropriate behaviour and practices of the people living in a specific
• The people know to avoid contact with human excreta and to hygienically dispose of human waste.
• The people’s behaviour displays a responsible attitude towards the hygiene of their families, the community,
and the environment. By being a responsible and hygienic individual you make sure that you do not
Q: Why does good sanitation matter?
A: The cholera epidemic has focused attention on the importance of good sanitation in breaking the cycle
of diseases spread by human excreta.
• promotes the spread of health problems - including chronic diarrhoea, intestinal worms, bilharzia, hepatitis,
and scabies - that can lead to malnutrition and stunting, especially in small children.
• places extra stress on the weakened immune systems of HIV positive people, accelerating the shift to
• has a major impact on the quality of life of people with AIDS, and the quality of life of those around them.
Sanitation matters for a range of other reasons too:
• privacy, dignity, convenience and safety for individuals.
• pollution impacts, especially on water sources.
• poverty reduction, through reducing vulnerability to disease and allowing low-income people to make
better uses of their resources.
For all these reasons good sanitation is an essential part of community development.
Q: What is needed to achieve improved sanitation?
A: Toilets are an important part of achieving good sanitation, but without proper public understanding about
why sanitation matters, and what is necessary to achieve good sanitation, toilets are not enough to break
the cycle of disease.
Good sanitation is achieved when everyone in a community understands the health importance of safe
excreta disposal, and takes the necessary practical steps to promote good personal hygiene and public
health. This includes access to, and consistent use of, a safe and hygienic toilet.
From the Municipality’s point of view, a sanitation improvement programme starts with a strong local health
team that can identify local sanitation-related health problems and work with residents to remedy them.
Key issues are poor hygiene practices, such as open defecation; contamination of water sources; malnutrition
caused by worms or ongoing diarrhoea, lack of safe and hygienic toilet facilities, lack of facilities for hand
washing and inadequate refuse removal. It is crucial to promote understanding of the linkages between water, sanitation, hygiene and health.
Q: What are the advantages of good sanitation behaviour?
• increased life expectancy with reduced morbidity and child mortality.
• savings in health care costs.
• reduced sick leave and higher worker productivity.
• better learning capacities among schoolchildren - increased school attendance, especially by girls.
• national pride and strengthened tourism.
• reduced water treatment costs.
Section 2: Sanitation, health and hygiene
Q: What is sanitation promotion?
A: Sanitation promotion describes a number of different activities that make up an effective approach to
improving sanitation. These include:
• Creating demand for better sanitation in communities through programmes which raise awareness about
why sanitation is important.
• Providing consumers with information about a range of sanitation options.
• Building and upgrading existing toilets.
• Promoting health awareness and safe hygiene practice.
• Providing users with information about their toilets to ensure that they are well maintained.
• Monitoring and evaluation to assess the impact of programmes and suggest changes where necessary.
Effective sanitation promotion involves teamwork and co-operation within a municipality. Keypeople here include:
• The Environmental Health Officer (EHO) - an outreach worker in communities who is responsible for
education about, and protection of, public health.
• The Community Development Officer (CDO), who is responsible for community liaison and community
development. Development facilitators play a critical role in strengthening and clarifying relationships between
individual household members, local government and all other roleplayers involved in achieving better
• The District Primary Health Care team, which is responsible for disease prevention and health promotion.
• Technicians and engineers, who plan and oversee the development of sanitation infrastructure.
Municipalities need to establish local sanitation teams to help co-ordinate sanitation activities, maximise
resources and improve communication.
There are six key tasks that face any Municipality setting out to promote improved sanitation:
• Identifing what problems poor sanitation is causing, and developing a coherent strategy to address them.
• Ensuring effective collaboration between the EHOs and the technicians who have traditionally managed
sanitation. This could be within the local municipality, or with the provincial or regional environmental health
• Ensure that the environmental health service has the resources to work in communities. Often EHOs do
not have access to transport and this severely limits their ability to be effective.
• Identifing and organising training opportunities for staff. This includes training in sanitation promotion and
in new skills such as community education and research. Visiting successful sanitation projects in other
areas is an excellent way of learning.
• Ensuring that community education happens - either by providing training for EHOs and other community
level workers, or by tendering work to non-governmental organisations (NGOs) and other agencies.
• Ensuring that sanitation promotion is informed by a thorough understanding of local practices and local belief
systems. Municipalities should assess local needs and priorities, provide baseline information, and evaluate
work already undertaken. EHOs, NGOs and other agencies have a valuable role to play in working with
local residents to identify problems and appropriate remedies.
Q: What is health and hygiene promotion?
A: Without safe hygiene practices, health benefits from better water and sanitation services will be limited.
Hygiene promotion has a positive impact on health even without improvements in water and sanitation services!
Hygiene promotion is mostly about changing people’s hygiene behaviour, a difficult and often slow process.
It begins with working with local residents to understand their beliefs, practices, and problems, and raising
awareness of the impacts of poor sanitation. Residents work with support teams to devise appropriate remedies.
Hygiene behaviours can be divided into five main areas:
• Safe disposal of human faeces.
• Protection and use of water sources.
• Home and environmental hygiene.
• Water and personal hygiene.
• Food hygiene.
Education about how to maintain and care for toilets is often part of hygiene education.
Key elements of a good hygiene promotion programme include:
• Close interaction between local residents and support teams to identify a specific local problem or behaviour
as the priority target.
• Household participation in identifying problems and needs and in finding solutions for those problems and
• Development of an effective communication or education campaign.
• Local level advocacy work.
•Evaluating the impact of the programme.
The best way to start a hygiene promotion programme is to understand local hygiene-related health problems
and then identify one simple hygiene behaviour improvement goal as the target. Don’t overload communities
with too many messages!
Q: How can sanitation improvement be integrated into broader health
A: Good sanitation is an essential part of primary and preventative health care, and hygiene promotion is just
one aspect of health promotion. All health programmes use the same approach of research, education and
One method of strengthening both a hygiene and sanitation promotion programme is to link it with other health
promotion projects. In this way, staff gain skills and expertise more quickly and available resources can be
Complementary health promotion programmes are:
• Promotion of breast-feeding.
• Food hygiene education.
• Prevention of TB.
• Home-based care services, especially around caring for people with AIDS.
Cyprian Mazubane - Deputy Director: Sanitation Support,
Department of Water Affairs and Forestry, Pretoria 012 336 6522
Marie Brisley - Deputy Director: Sanitation Co-ordination Support,
Department of Water Affairs and Forestry , Pretoria 012 336 6503
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