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Sanitation

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.

Introduction

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

managed properly.

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

environment

• 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

spread diseases.

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.

Poor sanitation:

• 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

full-blown AIDS.

• 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?

A:

• 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. Key people 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

sanitation.

• 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

service.

• 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

needs.

• 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

improvement programmes?

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

advocacy.

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

shared.

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.

 

Please contact:

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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