Optimizing household survey methods to monitor the Sustainable Development Goals targets 6.1 and 6.2 on drinking water, sanitation and hygiene: A mixed-methods field-test in Belize

Abstract

BackgroundThe Sustainable Development Goals (SDGs) require household survey programmes such as the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) to enhance data collection to cover new indicators. This study aims to evaluated methods for assessing water quality, water availability, emptying of sanitation facilities, menstrual hygiene management and the acceptability of water quality testing in households which are key to monitoring SDG targets 6.1 and 6.2 on drinking Water, Sanitation and Hygiene (WASH) and emerging issues.MethodsAs part of a MICS field test, we interviewed 429 households and 267 women age 15–49 in Stann Creek, Belize in a split-sample experiment. In a concurrent qualitative component, we conducted focus groups with interviewers and cognitive interviews with respondents during and immediately following questionnaire administration in the field to explore their question comprehension and response processes.FindingsAbout 88% of respondents agreed to water quality testing but also desired test results, given the potential implications for their own health. Escherichia coli was present in 36% of drinking water collected at the source, and in 47% of samples consumed in the household. Both questions on water availability necessitated probing by interviewers. About one quarter of households reported emptying of pit latrines and septic tanks, though one-quarter could not provide an answer to the question. Asking questions on menstrual hygiene was acceptable to respondents, but required some clarification and probing.ConclusionsIn the context of Belize, this study confirmed the feasibility of collecting information on the availability and quality of drinking water, emptying of sanitation facilities and menstrual hygiene in a multi-purpose household survey, indicating specific areas to improve question formulation and field protocols. Improvements have been incorporated into the latest round of MICS surveys which will be a major source of national data for monitoring of SDG targets for drinking water, sanitation and hygiene and emerging issues for WASH sector programming.

A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health

“…A multitude of studies focused on women and girls and demonstrated that women practiced poor sanitation, hygiene, and MHM practices, largely due to lacking resources. Sanitation facilities were commonly cited to not be safe, clean, and accessible (Kwiringira et al, 2014;Sato et al, 2016;Khan et al, 2017;Aluko et al, 2018;Angoua et al, 2018;Dendup et al, 2018;Desalegn et al, 2018;Njuguna, 2019;Winter et al, 2019). Basic needs, such as soap and washing facilities, and hygienic products, such as toothpaste were documented as hygiene barriers (Budhathoki et al, 2018;Lubon et al, 2018).…”

“…A small fraction (6%) of studies focused on the role of MHM, where women reported a lack of proper MHM products, such as clean pads, in addition to private areas and an absence of water provisioning for cleaning and sanitation needs (Khan et al, 2017;Budhathoki et al, 2018;Davis et al, 2018). Davis et al (2018) demonstrated how one in 10 students missed school due to menstruation, and this could, in part be attributed to menstrual stigma.…”

“…Women lack access to sustainable sanitation and hygiene facilities and resources. Kwiringira et al, 2014;Sato et al, 2016;Khan et al, 2017;Aluko et al, 2018;Angoua et al, 2018;Budhathoki et al, 2018;Dendup et al, 2018;Desalegn et al, 2018;Lubon et al, 2018;Winter et al, 2019 Gender differences in accessing a latrine were largely unremarkable. Ugbomoiko et al, 2009;Al-Delaimy et al, 2014;Alemu et al, 2017;Baker et al, 2018 Women and girls were burdened by latrines which lacked privacy and security.…”

Subnational regional inequality in access to improved drinking water and sanitation in Indonesia: results from the 2015 Indonesian National Socioeconomic Survey (SUSENAS)

“…In response to the data requirements for SDG monitoring, new questions and modules have been developed for inclusion in household surveys [14]; however, information on the quality of drinking water and sanitation services can more appropriately be obtained from government authorities that have regulatory oversight of service providers, and a mandate to monitor and value water resources and services [15]. …”

Wealthy, urban, educated. Who is represented in population surveys of women’s menstrual hygiene management?

“…9 Increased recognition of the importance of menstrual hygiene, and attention to the special needs of women and girls stated in Sustainable Development Goal (SDG) 6.2, mean PMA2020 may soon be joined by other largescale surveys seeking to monitor women's menstrual needs and practices. 10 In breaking new ground to provide the first national estimates of women's menstrual hygiene practices, PMA2020 data can offer unique insights into current needs and identify emerging measurement challenges. Using mobile-based data collection, the PMA2020 survey methodology applies automatic question filtering based on past answers to streamline the survey process and ensure respondents are only asked questions that are relevant to them.…”