Community Driven Environmental Health Project (CDEHP) Khyber Pakhtunkhwa Province, Pakistan ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Transcription

1 Community Driven Environmental Health Project (CDEHP) Khyber Pakhtunkhwa Province, Pakistan An Australian aid initiative implemented by International Rescue Committee on behalf of the Australian Government ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Research Analysis Study on Sanitation Marketing December 22, 2016 A research collaboration between the IRC and the University of Peshawar This publication has been funded by the Australian Government through the Department of Foreign Affairs and Trade. The views expressed in this publication are the author s alone and are not necessarily the views of the Australian Government. Page 1

2 Table of Contents Executive Summary... 4 Chapter Introduction... 6 Chapter Methodology...10 Key Informant Interviews (KIIs)...11 Chapter Findings and Analysis...13 Chapter Conclusion...23 Chapter Recommendations

3 Acronyms and Abbreviations IRC WASH WHO CLTS SLTS PATS PPP APCMA UC FGD KII RSM TSSM PVC PHED ODF KP International Rescue Committee Water, Sanitation and Hygiene World Health Organization Community Led Total Sanitation School Led Total Sanitation Pakistan Approach towards Total Sanitation Public Private Partnership All Pakistan Ceramics Manufacturers Association Union Council Focus Group Discussion Key Informant Interview Rural Sanitation Mart Total Sanitation & Sanitation Marketing Polyvinyl Chloride Public Health Engineering Department Open Defecation Free Khyber Pakhtunkhwa 3

4 Executive Summary International Rescue Committees is implementing the Community Driven Environmental Health Project (CDEHP) funded by the Australian Government s Department of Foreign Affairs and Trade (DFAT). This program aims to improve access to safe drinking water, improved and lowcost (affordable) sanitation in the rural communities of district Mardan, Nowshera and Peshawar of Khyber Pakhtunkhwa Province. The project relies for its success on a process of community engagement. One element of the project is an initiative to increase demand for sanitation through a sanitation marketing approach. This study explores the effectiveness of this approach through interviews and discussions with community members in communities involved in the project. The study is a joint collaboration between the IRC and the University of Peshawar, and comprises one element of the Knowledge and Learning scope of the project. Sampling In this particular study, we used a stratified random sampling technique, also sometimes referred as proportional or quota sampling, in which the total number of 100 respondents were divided into two subgroups i.e. men and women. Then a representative sample was taken via simple random sample in each subgroup. Total of 10 villages in three districts of Mardan, Nowshera and Peshawar were selected and the total sample size of the respondents was 100 with equal number of men and women respondents. KIIs were conducted with men and women and the responses were gathered. General Findings: 54% respondents responded that flush latrine is most commonly used along with other models and 43% respondents commented that they have no difficulties to access latrine use at time of need while 5% of people still had no latrine at their house. Perceptions of latrines were positive; most felt that their latrines were hygienic, and helped to keep them safe from disease. Concerning the safety of latrines, a majority responded that the 4

5 Pardah system is helpful to prevent from diseases and for ensuring dignity of family members and protection. According to 70% respondents; demand for sanitary items has increased at community level after the CDEHP intervention. 50% said that low cost sanitary marts are not available in villages while some low cost sanitary marts are available in the nearby villages. Overall, 53% respondents were satisfied with the cost of sanitation material. International Rescue Committee(IRC) staff and community committees have been active in enhancing demand for sanitation items and latrine use via dissemination of effective information and using various channels like; family members, Nazims., teachers, Village WASH Activists, Village WASH Committee members, and in a few cases, masons. Community capacity building is enhanced; about 85 % responded that they did receive trainings on Community Led Total Sanitation or Participatory Learning & Action. According to 48%, new sanitary shops have been initiated/ opened on their area after the CDEHP intervention. The following are some of the major challenges in sanitation up-scaling highlighted by the local community, with predominant response being poverty and lack of awareness; Lack of awareness Poverty lack of government focus No sanitary marts in village/ inaccessibility to such marts Unavailability of sanitary items Poor drainage system Peoples attitude towards environmental health issues Peoples lack interest about sanitation issues Lack of responsibility in ownership 97% of the respondents were in position to give the following predominant reasons for building household latrines. Reduction/prevention of diseases Clean and smell free environment Dignity, safety and privacy maintained for family members using latrine Convenience and accessibility. 5

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7 Introduction Sanitation Marketing is an approach to increase sustainable access to improved household sanitation at scale and close the huge sanitation access gap in developing countries. It does so by developing the sanitation marketplace to better serve the needs of low-income households. Public funds are used, not to provide latrines directly, but to strengthen the supply and demand sides of the sanitation market. Activities support both the expansion of private sector provision of improved sanitation products, services and demand, promotion and marketing activities to encourage poorer households to purchase these products and services. Sanitation marketing is an emerging field that applies social and commercial marketing approaches to scale up the supply and demand for improved sanitation facilities. It assists lowincome households in gaining sustainable access to improved sanitation they want and can afford. Sanitation marketing is relatively new approach in Pakistan. Many national and international organizations have worked to identify and develop low cost sanitary material that suits the poor rural communities. Community-Led Total Sanitation (CLTS) is an approach which helps rural communities to understand and realize the negative effects of poor sanitation and empowers them to collectively find solutions to their inadequate sanitation situation. CLTS is focused on igniting a change in sanitation behavior rather than constructing toilets. This is done by a process of social awakening that is stimulated by facilitators from within or outside the community. This approach concentrates on the entire community rather than on individual behaviors. The first significant step of CLTS is to end open defecation as an entry point while changing sanitation behavior. It starts by enabling people to do their own sanitation profile through appraisal, observation and analysis of their practices of open defecation and the effects these have. The water and sanitation program of the World Bank, UNICEF, PLAN Pakistan and many national sector players have carried out activities on the subject to improve sanitation access through social marketing. The already available document (IRC) on the subject was provided to the Department of Environmental Sciences research team. 7

8 It is believed that investing in Sanitation Marketing would not only strengthen the business economics of sanitation but also help in conjuring a network of innovative and versatile producers who can play a crucial part in encouraging the use and enhancing the demand of competitive low-cost sanitation market products. Research Purpose The purpose of the study is to: I. Review and summarize what we already know about baseline sanitation practices among rural populations including behaviors related to: a. Ending Open Defecation (OD). b. Constructing and/or building proper latrines. c. Use of latrines. d. Maintenance of latrines. e. Safe disposal of children s feces. II. Identify the key factors that influence these practices. III. Assess the main benefits sought from sanitation facilities. IV. Identify the barriers to adopting improved sanitation. V. Gauge households ability and willingness to either build sanitation facilities or pay for them to be built. VI. Provide data regarding the coverage of latrines that can assist in developing local sanitation markets. VII. Insights from the consumer research will assist IRC-EH to develop an evidence-based marketing and communication strategy aimed at improving sanitation at large scale and strengthens a sustainable/commercial market for sanitation and hygiene products aimed at low-income households. Objectives 1- Identify low cost sanitary marts and its marketing process. 2- Sanitation marketing successful models. 3- Link between sanitation marketing and CLTS. 8

9 4- To study the available latrine options, its cost and effectiveness in addressing the challenge of open defecation. Specific objective Improve C/SLTS sustainability through various technology options especially low-cost, affordable sanitation market evaluation. 9

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11 Research Methodology Data collection a- KIIs with communities. b- Sanitation marketing documents review. Key Informant Interviews Key informant interviews are qualitative in-depth interviews with people who know what is going on in the community. The purpose of key informant interviews is to collect information from a wide range of people including community leaders, professionals, or residents who have firsthand knowledge about the community. This technique provides free exchange of ideas. The required data was obtained by further elaborating these questions and constructing a subset of multiple questions for each major question to be answered. The responses were carefully recorded and entered. Methodology Documents review KII s Key Informant Interviews (KIIs) KIIs mainly focused on discussion around: Eliminating open defecation Identification of low cost sanitary marts and its marketing process Link between sanitation marketing and CLTS and sanitation marketing successful models Study of the available latrine options, their cost and effectiveness in addressing the challenge of open defecation Sampling The three districts were divided into three subgroups while simple random sampling among the sample will be carried out in each subgroup. The sample from total population was carried out as following: 11

12 Total No of Villages, N = 100 Sample size, n = 10 (10% of N) Per village HH KII= 10 (5 male/ 5 female) Total HH KII= 100 In this case, four villages were selected in Nowshera district whereas three each were selected in Mardan and Peshawar through simple random sampling in each district. Data review and arrangements The water and sanitation program of the World Bank, UNICEF, PLAN Pakistan and many national sector players have carried out activities on the subject to improve sanitation access through social marketing. The already available documents on the subject were provided to the Department of Environmental Sciences research team by IRC. 12

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14 Results and Discussion This section entails detailed findings per Union Council of the Sanitation Market Survey conducted across the three districts in KP. The research involves 100 people altogether including 50 women and 50 men from all three project districts. KIIs were conducted with both men and women respondents through a structured questionnaire. Combined responses of both men and women community members against each research objective are examined and interpreted through percentage. Key Research Questions and Results Some of the major questions that this research has aided in providing answer to include; 1- How can open defecation be eliminatied effectively and what are the challenges faced by community? 2- Can community Identify low cost sanitary marts and its marketing process? 3- What is the link between sanitation marketing and CLTS and sanitation marketing successful models? 4- What are available latrine options, its cost and effectiveness in addressing the challenge of open defecation? The Challenge of open defecation In response to questions around access to and type of toilet at their house, the largest proportion of 54% said that they had access to a flush latrine. However mixed answers were also observed including flush latrine with septic tank 11%, pour flush latrine with septic tank 10%, no latrine in HH level 6%, pit latrine 6%, and practice open defecation 6%,. When the community was asked about the accessibility to latrine, 43% of respondents noted no difficulties of access, with smaller numbers noting difficulties because of large family size (18%) difficulties in rainy weather (4%) or not having a toilet at the house (5%). Respondents noted rapid population increase in villages along with severe low income and lack of awareness as reasons for limited access to the toilets. 14

15 About the status whether their latrine is hygienic or not, 5% noted that there is a bad smell, but most responded that they used chemicals chemicals and detergents for cleanliness, and that their toilets are safe and prevent disease. Normally people use cleaning detergents such as harpic, surf and phenyl for cleanliness of toilets. Mixed views came across when respondents were asked how satisfied are you with durability of latrine? 5% were uncertain, and 5% were not satisfied due to poor design; 4% responded that their toilet would only be useable for another two years. The remainder believed that their toilet would be used and useable for ten years or more. When it was asked to what extent the community believed latrines impact peoples safet, from disease, 39% responded that the Pardah system kept people safe from diseases; 15% responded that latrine use ensure dignity of women and protection, 5% responded that latrine is safe to use for ablutions convenience, protection from diseases, and comfort in rainy season. Due to moral and religious obligations they also frequently used for cleanliness. The major responses of community are briefly summarized in figure

16 Open defecation elimination & challenges of community 54% 43% 33% 39% Yes, Flush Latrine Easy access Enhanced cleanliness Safe Environment Sanitation options at community level HH Latrine Use Impact Still Open Defecati Challenge Yes, flush latrine Use increase with access. Improved hygiene & healthy environment Healthy life style and behavioral changes Control on diseases Increase use of latrines Pardah system, religious obligation Awareness and healthy society Figure 3.1 Impact of open defecation elimination from community study Identify low cost sanitary marts and its marketing process Respondents were asked about any kinds of sanitary mart available at their locality for purchase of materials needed to construct toilets? 50% responded that there was no mart of any kind in their locality, while the 2nd major response of 30% respondents was that yes, sanitary marts were available, and almost all kind of items are available on it. 15% responded that few sanitary marts were available but that all the key materials are available on it. 16

17 Respondents were asked what sanitary items are available in those marts, and frequently mentioned products included comodes, bricks, elbow bends, towels and tissues. Water tanks, cement, washing basins and soap were less frequently mentioned. One question explored Did the demand of sanitary material increase at your locality after the intervention of CDEHP? If yes how? 70% respondents said that demand is increased as the community gained awareness about sanitation options, 15% respondent had no opinion, while 13% said that after the intervention, their community gained awareness about sanitary materials like hand washing basin, pipes, water tank, cements, PVC pipes A majority were satisfied with access to sanitation information. The main information and communication channels were NGOs, IRC staff and other family members, Nazims., teachers, Village WASH Activists, and Village WASH Committee members. Masons were mentioned as a source of information in some cases, but less often than the other channels. Low cost sanitary marts and its marketing process Impact Sanitary mart availability 50% Sanitary items are available Increase in demand of sanitary material after the intervention of CDEHP? Access of sanitation information & communication channels Availability of sanitary items in the market 30% 70% 30% 26% Sanitation Marts Feasibility Increased awareness Enhanced confidence Improvement in hygiene and cleanliness practices at HH level Women needs/issues highlighted. Pilot studies for future policies IRC staff and community gathering disseminated effective information 30% Figure 3.2: Overall results of low cost sanitary marts and its marketing process 17

18 Link between sanitation marketing, CLTS and sanitation marketing successful models Community capacity building is enhanced through CLTS and PLA. About 85% of interviewees responded that they did receive CLST or PLA training, while 15 % either didn t know or never received such training. The impact of those trainings in creating demand for sanitation options was also assessed. Of those who were involved in trainings, a greater majority (88%) responded that those trainings were very helpful. It helped them in enhanced use of soap for hand washing, elimination of open defecation, safe handling of water, proper latrine use, and better hygienic practices adopted. 12 % either did not know the answer or declined to respond. According to 40% respondents, low cost latrine models were shared through latrine charrettes, though 9% responded that latrine charrettes were shared with male community members only and women were ignored. 35% of respondents didn t know or had no idea on whether such material was shared, and 10 % responded that although they have not seen latrine charrettes, they had seen different latrine models in IEC material and to some extent it was helpful to take idea from those models. 93% of respondents said that there were masons in the village, or in a nearby village, who can construct latrines. The remaining 7% didn t know if such manpower is available in their area. While half of the community respondents (50%) believed that these masons had received training from IRC, 35% had no knowledge whether those masons received any training, and 15% responded that no training was provided to these masons by the IRC staff. Sanitary Market Expansion after IRC intervention 48% responded that no new sanitary shops have been initiated/ opened in their area after the IRC intervention. 30% responded that new sanitary shops have been initiated after IRC intervention, and the number of new shops initiated range from 1-3 in number in each village. They also responded that these new shops are not sufficient as the demand for the sanitary material has increased after IRC project. According to 8% of respondents, the IRC intervention has sensitized local community to sanitary needs but due to poverty and financial hurdles new shop initiatives cannot be taken. 14% had no knowledge of such initiatives. The following are some of the major challenges in sanitation up-scaling highlighted by the local community, with predominant response being poverty and lack of awareness; 18

19 Lack of awareness Poverty lack of government focus No sanitary marts in village/ inaccessibility to such marts Unavailability of sanitary items Poor drainage system Peoples attitude towards environmental health issues Lack of responsibility towards ownership IMPACTS Very Helpful 88% Enhanced use of soap for hand washing Community capacity building for CLTS and PLA Yes (85%) No (7%) Don t Know 12% Elimination of open defecation Safe handling of water proper latrine use Better hygiene practices adopted Translated Demand for Sanitary material increased, greater community sensitization towards EH needs Don t Know (14%) No (30%) Yes (48%+ 8%) Increased demand for the sanitary material New businesses initiated in Sanitary material Figure 3.3: Link between sanitation marketing and CLTS 19

20 Available latrine options and its cost and effectiveness in addressing the challenge of open defecation While discussing the available sanitation models in village, 45% of the respondents said that various latrine models are available in their respective villages, for example, the community built modern latrine models, pit flush, pour flush etc. On the other hand 17% of respondents still believe that no latrines and sanitation models are available in the village whereas 34 % have no idea whether such models are available. About 4% in the community still practice open defecation. While very few (3%) respondents didn t have an answer when asked about the three reasons for building house hold latrine, a majority (97%) of the respondents were in position to give the following predominant reasons behind building household latrines. Reduction/prevention of diseases Dignity ensure Clean and smell free environment Safety and privacy maintained for women Convenience and accessibility As far as the affordability of the sanitation/ latrine materials and the labour/mason is concerned, according to 70% respondents who were willing to estimate, it ranged from Pk. Rs , with further details on the cost elaborated in the figure below. Figure 3.4: Cost of material and labor for latrine building as perceived by community 20

21 Sanitary Items and Labor Cost Satisfaction and Affordability A greater majority of the respondents were satisfied either fully (53%) or to some extent (8%) with the cost of the material used for latrines and 15% were found to be unsatisfied with the cost. 16% of the respondents either had no idea of the cost or they didn t know the answer. However, 8% of the respondents had affordability issues. The respondents unanimously agreed that the construction of latrines by other community members is strongly recommended, but they believe (47%) that mostly low cost latrines are affordable in their community while higher cost latrines cannot be afforded. Conducting regular meetings, community mobilization, hygiene sessions, new latrine construction, arranging cleanliness campaigns, sanitation committee formation, dissemination of positive sanitation messages and regular follow-ups are some initiatives that the community/committee believe would be effective to sustain demand for sanitation items. According to the respondents responses, 24% had taken no initiatives or they don t know if such steps were taken, while the remaining 76% responded that VWCs and VWAs had taken actions for the new initiatives. Therefore 83% respondents were satisfied with the role of the committee/activists in the CLTS and PLA process while 17% were not satisfied with their role. 21

22 Challenge of Open defecation No Response (34%) No model available (18%) Yes, Latrine models available (45%) Still practice open defecation (5%) No Response (3%) Support Latrine building/ Cost of Latrine Material Strongly support reasons for Latrine building (97%) Not satisfied (15%) Latrine affordable/ satisfied with cost (53%) No response (16%) Not Affordable (8%) To some extent (8%) Strongly Recommending Latrine building to community Initiatives by the community/committee to create demand for sanitation items Figure 3.5: Latrine cost and effectiveness in addressing the challenge of open defecation 22

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24 Conclusions The following conclusions can be drawn from this study: The program has been very successful in community capacity building and the CLTS trainings were considered very helpful by a majority of the respondents. As a result there is enhanced use of soap for hand washing, elimination of open defecation, safe handling of water, proper latrine use and better hygienic practices adopted. Considerable changes can be observed in terms of increased demand for sanitary items and ultimate enhancement in the sanitation market. However sanitation up-scaling is still facing serious challenges at village level. They include; lack of awareness, poverty, lack of government focus, lack of sanitary marts in village, inaccessibility to such marts, unavailability of sanitary items, people s attitude towards environmental health issues, and lack of responsibility towards ownership. Open defecation is being eliminated due to CLTS interventions and resultant capacity building, but it still is a challenge and may pose a threat even at lower prevailing percentage, especially in areas with greater poverty. 5% of the community still has no latrine facility and this should not be ignored by the program. Quite diverse reasons came up for supporting latrine building at home, These include; safety and accessibility, safe from diseases, environment protection and smell avoiding, ensuring dignity/pardah of female and protection. Although many realize the need for latrine building and its importance, affordability still remains an issue. The cost can range from Pk. Rs (a huge range depending on the model and type of latrine system). It is important to narrowly analyze the affordability issue and cost satisfaction further. Whereas most respondents were apparently satisfied with the cost of labor and material for latrine building, when further asked about affordability a rather different response was observed. Only low cost latrines and rather simpler model latrines are affordable by the communities. So being satisfied with the cost in a community does not always mean that the given community is also able to afford it or willing to pay for it in some cases. Owing to the awareness among the community, they kept latrine construction in the first priority because they spending more amount for their health maintenances. So, they are paying health expenditure in the latrine affordability. 24

25 Sanitation markets are still not present in 50% communities and no significant change is observed in existing market after the CDEHP interventions. On the other hand demand for such item at community level has increased for sanitation option 70%, after the intervention of CDEHP. On the account of access of sanitation information, IRC staff community/committee have taken some initiatives to create demand for sanitation markets ; e.g. conducting regular meetings, community mobilization, hygiene sessions, cleanliness campaigns, and dissemination of positive sanitation messages. There is a greater opportunity for sanitation markets. The poverty aspect of the community needs to be addressed and tackled so that the market will also flourish and at the same time poor communities also have sanitation facilities. In order for poor communities to purchase sanitation items from their own capabilities such as purchasing items for Pit and VIP latrines, the materials using for these latrines need to be low cost and easily available in the local markets, while the shops owners offering credits to the purchasers who are not paying at once, a common practice of the local businesses. 25

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27 Recommendations The findings of this study can be addressed by adopting the following important practices: The monitoring of Sanitation Up-scaling Schemes must involve the community using the Participatory Monitoring and Evaluation approach to ensure participation of women and marginalized groups where possible. Increased awareness about health, hygiene and sanitation needs to be generated among the target audience which would in turn result in increased demand for sanitation products. Therefore, it is recommended to conduct an in-depth consumer market research to understand consumer behavior and preferences and accordingly carry out awareness raising initiatives. Hand washing facilities are included as integral part of the latrine design, however it is pertinent to sensitize the communities on using them on regular basis. Sensitization and exclusive trainings on the concept, design, benefits, use and sale of low cost sanitation options need to be imparted to entrepreneurs, masons, marts and community alike. Special focus should be on use of indigenous materials for building latrine options as they are cost effective, well suited to needs and demands of the locals and will also result in income generation. Local Government notified open defecation free committees officially at village and Neighborhood Council (NC) and The Sanitation Up-scaling Schemes shall be monitored by the respective committees. Latrine affordability may be enhanced by the following incentives depending upon the resources and active involvement of the community members; Latrine material to the poorest/ subsidized rates Hygiene materials available in local marts with reasonable price Rehabilitation of latrine, local masons and labors are fully aware from rehabilitation work. It is essential to build the capacity of local sanitation market owners and builders/masons about construction of low cost sanitation options. The mart owners and sellers also need to be educated about having an appropriate marketing mix as availability of need based products at convenient locations and optimal prices would result in increased sales and revenues. In light of 27

28 the research findings it is also evident and well understood that technical and advisory support to mart owners for identification of place and usage of effective promotion methods based on local cultural norms from the very start of their enterprises will also play a vital role in building enterprises. Moreover repair and maintenance services must also be provided. It is strongly recommended that the Government of Pakistan must create an enabling working environment for appropriate hygiene and sanitation interventions (and active organizations) so that people have access to sanitation facilities and improved hygiene. To create ownership of the government entities and improve the participatory process among all stakeholders in sanitation up scaling projects. Project oversight and district coordination committees were formed in the start of the project to join hands with government departments for smooth implementation of the project. With continuous advocacy and liaising with local government, project oversight committee is known as Provincial Oversight Committee with a broader role not only in CDEHP but all WASH partners. Sub-committees like technical working group and village open defecation free declaration committees are formed and are regularized by the government department and is working actively in the area. In order to address different challenges of sanitation, we must ensure the most efficient, judicious and transparent utilization of funds allocated for the Sanitation up Scaling projects. We should encourage investments including mobilization of local resources for the Sanitation Upscaling. Generate evidence through research for effective advocacy and behavioural change. A research and advocacy fund be established at the Division of Climate Change to support the action research for sanitation. Work for the constitution of a National Council or Body for WASH to underpin the support for improved sanitation and hygiene, and provide guidelines and framework for the regulation of professionals and private sector organizations involved in sanitation. PRA is widely used in the development sector to proactively involve the communities to identify the most pressing needs in their communities. These needs may vary from clean drinking water, improved health, education facilities, street pavement and sanitation related issues. Rich indigenous knowledge of the COs along with the capacity building through Community 28

29 Management Skill Training (CMST) has played a useful role in planning their community based physical infrastructures. Under the programme, the poor and extremely poor communities in the rural areas benefitted from access to sanitation services, improved access to water, health and hygiene promotion and through supply side sanitation interventions. The programme maintained a gender and vulnerability focus which is demonstrated in operations and results. Findings suggest that using a central training organisation proved effective; though with some constraints which if addressed should help make it even more effective. Furthermore studies can be extended to other districts to review and summarize about baseline sanitation practices among rural populations including behaviors. 29