Patterns and Drivers of Household Sanitation Access and Sustainability in Kwale County, Kenya

Legge, Hugo; Halliday, Katherine E.; Kepha, Stella; Mcharo, Carlos; Witek-McManus, Stefan; El‐Busaidy, Hajara; Muendo, Redempta; Safari, Th’uva; Mwandawiro, Charles; Matendechero, Sultani; Pullan, Rachel L.; Oswald, William E.

doi:10.1021/acs.est.0c05647

Cited by 10 publications

(12 citation statements)

References 47 publications

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“…This improves the effect that schools have on maintaining households’ perceived value of sanitation, but this effect is still limited by median educational attainment (retention years in school). The sanitation in schools effect follows from the assumption that the more years an individual spends in a school with improved sanitation, the less that individual needs continuous sensitization regarding the value of sanitation (this agrees with findings from ref ). In the status quo, sanitation access in schools is dependent on district resources (but never dips below 30%).…”

Section: Resultssupporting

confidence: 86%

Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling

McAlister,

Namakula,

Annis

et al. 2023

Environ. Sci. Technol.

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Improved sanitation provides many benefits to human health and well-being and is integral to achieving Sustainable Development Goal Six. However, many nations, including most of sub-Saharan Africa, are not on track to meeting sanitation targets. Recognizing the inherent complexity of environmental health, we used systems thinking to study sanitation sustainability in Uganda. Our study participants, 37 sanitation actors in three rural districts, were engaged in interviews, group model building workshops, and a survey. The resulting model was parametrized and calibrated using publicly available data and data collected through the Uganda Sanitation for Health Activity. Our simulations revealed slippage from improved sanitation in all study districts, a behavior reflected in real interventions. This implies that systemic changes-changes to the rules and relationships in the system-may be required to improve sanitation outcomes in this context. Adding reinforcing feedback targeting households' perceived value of sanitation yielded promising simulation results. We conclude with the following general recommendations for those designing sanitation policies or interventions: (1) conceptualize sanitation systems in terms of reinforcing and balancing feedback, (2) consider using participatory and simulation modeling to build confidence in these conceptual models, and (3) design many experiments (e.g., simulation scenarios) to test and improve understanding.

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Section: Resultssupporting

confidence: 86%

Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling

McAlister,

Namakula,

Annis

et al. 2023

Environ. Sci. Technol.

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“…Households within areas with coarser soil types have been less likely to have sanitation facilities compared to areas with finer soils, 26 as coarser soils are less cohesive and facilitate percolation of water at a higher rate, which makes latrine construction more susceptible to flooding and collapse of existing latrines. 27 Toilet age was categorized as less than 1 year versus 1 year or more and was respondent-reported.…”

Section: Methodsmentioning

confidence: 99%

Assessing the Sustainability of an Integrated Rural Sanitation and Hygiene Approach: A Repeated Cross-Sectional Evaluation in 10 Countries

Apanga

Freeman

Sakas

et al. 2022

Glob Health Sci Pract

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The Sustainable Sanitation and Hygiene for All (SSH4A) approach was designed to increase sanitation and hygiene coverage with the premise that by working with local government to plan and budget for the intervention, access and uses would be sustained.n In 6 of the 12 program areas where SSH4A was implemented, we found sustained basic sanitation coverage 1-2 years post-implementation; all program areas, including those with slippage, had higher sanitation coverage than at baseline. n Community, household, and structural factors were associated with higher toilet sustainability, including higher household socioeconomic status and living in communities with higher baseline sanitation coverage.

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“…Washable floors, aesthetic features, and private ownership have been associated with sustained latrine use. 16,48,49 In contrast, community-led total sanitation and top-down interventions have been criticized for focusing on simple service provision, sometimes resulting in low-quality, unimproved facilities 12,50 that are eventually abandoned. 9,45 This study did not find evidence that the household head gender, household gender makeup, or gender of decision makers was linked to reaching improved sanitation.…”

Section: Resultsmentioning

confidence: 99%

Do Sanitation Marketing Activities Increase Households’ Likelihoods of Reaching Improved Sanitation or Involving Women in Decision Making?

Vicario,

Annis,

Namakula

et al. 2023

Environ. Sci. Technol.

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Poor sanitation causes 30% of diarrheal deaths globally, and much of the world has struggled to finance top-down interventions. Sanitation marketing is a demand-led approach that uses a mixture of social and commercial marketing methods and direct sales to households. However, little is known about its impacts on household decision making. This mixed-methods study uses data from eight focus groups and 86,666 household surveys from participants in a five-year sanitation marketing program in Uganda. Logistic regression models identified 10 variables predicting attainment of improved (limited or basic) sanitation and four variables predicting female involvement in decision making. Triggering session attendance increased chances of reaching improved sanitation by 15−28%, depending on who attended, and by 19% if the household found the session motivational. Although women were engaged in decision-making conversations, they were not viewed as primary decision makers, even in female-headed households. Women were more likely to become involved in decision making if they had attended triggering sessions with men (+70%) or engaged with sales promoters alone (+74%) or with men (+78%). For both outcomes, joint activity engagement was more effective than male or female engagement alone. This work highlights two sanitation marketing activities as pathways to improving latrine coverage and women's decision-making agency.

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Patterns and Drivers of Household Sanitation Access and Sustainability in Kwale County, Kenya

Cited by 10 publications

References 47 publications

Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling

Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling

Assessing the Sustainability of an Integrated Rural Sanitation and Hygiene Approach: A Repeated Cross-Sectional Evaluation in 10 Countries

Do Sanitation Marketing Activities Increase Households’ Likelihoods of Reaching Improved Sanitation or Involving Women in Decision Making?

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