Improving Sanitation and Hygiene through Community-Led Total Sanitation: The Zambian Experience

Abstract

In 2012, approximately 5.6 million Zambians did not have access to improved sanitation and around 2.1 million practiced open defecation. The Zambia Sanitation and Hygiene Program (ZSHP), featuring community-led total sanitation, began in November 2011 to increase the use of improved sanitation facilities and adopt positive hygiene practices. Using a pre-and post-design approach with a population-level survey, after 3 years of implementation, we evaluated the impact of ZSHP in randomly selected households in 50 standard enumeration areas (representing 26 of 65 program districts). We interviewed caregivers of children younger than 5 years old (1,204 and 1,170 female caregivers at baseline and end line, respectively) and inspected household toilet facilities and sites for washing hands. At end line, 80% of households had access to improved sanitation facilities versus 64.1% at baseline (prevalence ratio [PR] = 1.25; 95% CI: 1.18-1.31) and 14.1% did not have a toilet facility compared with 19.4% at baseline. At end line, 10.6% of households reported living in an open defecation-free certified village compared with 0.3% at baseline (PR = 32.0; 95% CI: 11.9-86.4). In addition, at end line, 33.4% of households had a specific place for washing hands and 61.4% of caregivers reported handwashing with a washing agent after defecation or before preparing food compared with 21.1% (PR = 1.59; 95% CI: 1.39-1.82) and 55.2% (PR = 1.11; 95% CI: 1.04-1.19) at baseline, respectively. Community-led total sanitation implementation in Zambia led to improvements in access to improved sanitation facilities, reduced open defecation, and better handwashing practices. There is however a need for enhanced investment in sanitation and hygiene promotion.

Understanding Open Defecation in the Age of Swachh Bharat Abhiyan: Agency, Accountability, and Anger in Rural Bihar

“…Individually-oriented interventions focused on behavior change leave households accountable for the failure to adopt safe sanitation practices. Education and social marketing have been only modestly successful in the sustained reduction of OD in India or elsewhere [34,50]. Behavior change interventions have also been critiqued because, for those who cannot change their behavior due to structural reasons, they generate "additional social stigma for failing to maintain new social norms regarding health behaviors" [36] (p. 194).…”

Mapping of Diarrhea in Toddlers with Open Defecation Free (ODF) Status in Tuban Regency

“…A program such as Community-Based Total Sanitation (CBTS) will increase the latrine ownership of each household by at least twice the percentage, which was evident from a study conducted in Ghana and Tanzania. Likewise, based on the findings in Mali, there was a decrease of at least 24% for people who practice open defecation (20). Similar studies in Indonesia showed that in the CBTS program, especially the aspect of not practicing open defecation had a relationship with diarrhea (2,17).…”

Gender Equality and Social Inclusion in Relation to Water, Sanitation and Hygiene in the Oromia Region of Ethiopia

“…Though the program is in implementation, availability and proper use of latrines, water, and hand washing facilities remains low in Ethiopia. The approach requires enhanced investments and amplified efforts across the WASH sector to deliver strong outcomes [ 29 , 30 , 31 ]. Similarly, Ethiopia’s 2017–2022 Growth and Transformational Plan (GTP) centers WASH, inclusion, and the needs of women, youth, and vulnerable people, however the intended results remain well behind targets.…”