Toilet training: what can the cookstove sector learn from improved sanitation promotion?

Abstract

Within the domain of public health, commonalities exist between the sanitation and cookstove sectors. Despite these commonalities and the grounds established for cross-learning between both sectors, however, there has not been much evidence of knowledge exchange across them to date. Our paper frames this as a missed opportunity for the cookstove sector, given the capacity for user-centred innovation and multi-scale approaches demonstrated in the sanitation sector. The paper highlights points of convergence and divergence in the approaches used in both sectors, with particular focus on behaviour change approaches that go beyond the level of the individual. The analysis highlights the importance of the enabling environment, community-focused approaches and locally specific contextual factors in promoting behavioural change in the sanitation sector. Our paper makes a case for the application of such approaches to cookstove interventions, especially in light of their ability to drive sustained change by matching demand-side motivations with supply-side opportunities. Abbreviation: DALY: Disability-adjusted life year; CHC: Community Health Club; CLTS: Community-Led Total Sanitation; HAP: Household air pollution; BM-WASH: Integrated Behavioural Model for Water, Sanitation and Hygiene; ICS: Improved cookstove; LPG: Liquefied petroleum gas; NBA: Nirmal Bharat Abhiyan; NGO: Non:governmental organisation; OD: Open defecation; ODF: Open defecation free; HAST: Participatory Hygiene and Sanitation Transformation; RANAS: Risks, Attitudes, Norms, Abilities and Self-regulation RCT: Randomised controlled trial; (Sani) FOAM: Focus, Opportunity, Ability and Motivation; SBM: Swachh Bharat Mission; TSC: Total Sanitation Campaign; WASH: Water, Sanitation and Hygiene.

Systems Science Approaches for Global Environmental Health Research: Enhancing Intervention Design and Implementation for Household Air Pollution (HAP) and Water, Sanitation, and Hygiene (WASH) Programs

“…WASH is considerably more mature than the HAP field and offers experience with more types of interventions. The HAP community can learn a great deal from WASH experiences (Clasen and Smith 2019;Sesan et al 2018). However, results from these recent WASH trials also suggest that major challenges underlie the successful implementation of environmental health interventions in low-income settings.…”

“…Poor WASH is also associated with a range of adverse health outcomes, including enteric viral, bacterial, and protozoan pathogen infections and diarrheal disease, schistosomiasis, and soil-transmitted helminth infections (Clasen et al 2015;GBD 2016Risk Factors Collaborators 2017. Technological solutions designed, investigated, and evaluated in laboratory settings, including clean cookstoves and water filters, offer promising solutions, but seldom deliver expected results when implemented in real-world settings (Clasen and Smith 2019;Sesan et al 2018). Recently completed randomized controlled trials (RCTs) have returned disappointing results for interventions that are already in widespread use, raising questions regarding basic assumptions of efficacy, effectiveness, potential for scale-up, and technology and policy options to address these priority environmental health concerns (Luby et al 2018;Mortimer et al 2017;Null et al 2018).…”

“…Third, these technology-focused interventions have both struggled to achieve the high levels of reach, adoption, and adherence necessary to reduce exposure and improve health. Finally, the emissions/effluents from one home have wider ecological impacts or spillover effects, suggesting that high levels of adoption are required in order to achieve favorable health outcomes at individual, household, and community scales (Sesan et al 2018).…”

“…2015 ; GBD 2016 Risk Factors Collaborators 2017 ). Technological solutions designed, investigated, and evaluated in laboratory settings, including clean cookstoves and water filters, offer promising solutions, but seldom deliver expected results when implemented in real-world settings ( Clasen and Smith 2019 ; Sesan et al. 2018 ).…”

“…WASH is considerably more mature than the HAP field and offers experience with more types of interventions. The HAP community can learn a great deal from WASH experiences ( Clasen and Smith 2019 ; Sesan et al. 2018 ).…”