Course 4 Unit 2 Social institutional policy and

Course 4 Unit 2 Social, institutional, policy and gender aspects Teacher Mariska Ronteltap 1 m. ronteltap@unesco-ihe. org

Course 4 Unit 2 Social, institutional, policy and gender aspects Part A: Social aspects and hygiene education Part B: Institutional and policy aspects Part C: Gender aspects (separate presentation) 2

Course 4 Unit 2 Part A: Social aspects and hygiene education http: //www. wsscc. org/ 3

Sanitation system boundary conditions A sanitation system encompasses: § the users of the system, § collection, § transport, § treatment and § management of end products of: • human excreta • greywater • solid waste • industrial wastewater • and storm water so much more than just a toilet! Source: Patrick Bracken (ex-GTZ) presentation at Stockholm Water Week, 2004 4

Interactions of relevant systems in society Economic system Social system Political system Water and Sanitation System Educational system Health system Institutional system Housing system Source: Elisabeth Kvarnström (SEI, Sweden) 5

Cultural factors “Faecophilia-faecophobia” continuum § In many societies, there is a fear of human excreta (some people call this: “faecophobia”) and many taboos around human excreta management § In other societies people have no problems talking about faeces (some people call this “faecophilia”) • one example is China* § It is important to work with these cultural barriers and taboos and not to ignore them! Use participatory methods to facilitate change (“bottom-up” approach) § One unavoidable draw-back is that this may well take longer than the traditional “top-down” approach (see also Part B on participatory approaches) * Watch this video clips to hear from Uno Winblad about the special situation in China with regards to “ faecophilia” and “nutritional imperative” (see next slide): mms: //mediaserver. ihe. nl/course/video_general/ecosan/human_excreta 18_256 kbps. wmv 6

The “nutritional imperative” Societies that use excreta or have used it in the recent past in agriculture or aquaculture are those which are most densely populated: Europe, India, China and South-east Asia § Economic appreciation of soil fertility § Use of fresh excreta as fertiliser was often combined with the practice to always cook the food and avoid eating raw vegetables, thus reducing potential disease transmission Societies with a low population density have not had the need to use these nutrients in food production (e. g. countries in sub. Saharan Africa) WHO (2006), Chapter 7, p. 109 (under Extra Materials) 7

Perception (emotional responses) of faeces versus water Perceptions are not always logical nor rational ! Faeces Water • dark • defiled • evil dangerous • bad • repulsion • clear - reflecting light • pure • God/heavenly - safe • good • attraction Source: based on Heeb et al. (2007) Module M 4 -2 on Socio. Cultural aspects Associations usually negative Associations usually positive 8

People’s perceptions of urine and faeces People’s perceptions of urine rarely documented: § Presumably fairly relaxed § Urine has been used to smear wounds and as an insecticide to kill banana weevils in East Africa • Disinfection property of urine is quite well known § Some people even drink urine and view this as beneficial to their health (!) § Urine’s richness in nutrients is not so well known (yet) People’s perceptions of faeces: § § Fresh faeces are perceived as abhorrent by most people One’s own faeces are perceived as not so offensive Dried and composted faecal material has a different appearance: soil-like Projects with dry sanitation: cultural avoidance to handle the product may still exist “Stepping into urine on the ground is quite different from stepping into faeces!” (Gumbo Ph. D thesis, 2005) Source: WHO (2006), Chapter 7, p. 110 9

Course 4 Unit 2 Hygiene education: overall aims – To change hygiene behaviour for better livelihood – To improve water quality and the environment through better hygiene practices A very good source of information on this topic is the website of the Water Supply and Sanitation Collaborative Council (WSSCC) http: //www. wsscc. org/ • See their WASH campaign (WASH= water, sanitation and hygiene) www. usaid. gov/bj/images/hygienebet. jpg There is also a group of video clips produced by UNICEF which deal with hygiene education, you can view them here: ** 10

Hygiene education: Key behaviours for breaking the cycle of disease transmissions Hand washing with soap (there may be a need to subsidise soap): § § § after using the toilet after cleaning up the faeces of children or elderly people after helping children to use the toilet after handling animals before food preparation or feeding children Measures to keep drinking water clean Hygienic food preparation and storage and reheating (safe food handling) 11

Hygiene education: Key behaviours for breaking the cycle of disease transmissions § Consistent use of toilets (for adults and children) to keep faeces out of the environment § Stop flies from coming into contact with faeces § Stop children and animals from coming into contact with faeces § Handling excreta only with gloves, rakes, shovels; and wearing suitable footwear, e. g. boots § Use of footwear to stop helminth ova infections via soil attached to feet, and infections via the skin § Availability of anal cleansing material at the toilet (toilet paper, water, leaves, or whatever else is used locally) § See also the Ph. D thesis of Susanne Herbst on hygiene issues in Uzbekistan (see Course 1 Unit 2 Extra Materials) 12 Source: Parts of this slide are from Winblad and Simpson. Hebert (2004)

Reminder: Effectiveness of hardware and hygiene interventions in reducing diarrhoea morbidity 13

Hygiene education and water quantity § Sufficient quantity of water is important (more important than quality of the water) § People don’t wash hands if water is too limited § Water for handwashing can be lower quality than drinking water, e. g. from rainwater harvesting or high salinity water § See interview with Sumita Ganguly (UNICEF Delhi) on this topic on this site: mms: //mediaserver. ihe. nl/course/video_general/ecosan/human_excreta 16_256 kbps. wmv 14

Hygiene education and gender Public awareness should be designed in consultation with communities taking into account women, children – their cultural differences, and behaviour etc. Focus on gender differences is of particular importance – knowing that women influence the hygiene behavoiur of young children – and men serve as role models in sustaining changes in habits See also Part C of this presentation Source: United Nations Economic and Social Council (2005) 15

Hygiene education and people living with HIV or AIDS For People Living With HIV/AIDS (PLWHA) (this includes households/family members of HIV positive people) hygiene education is even more important § Therefore, hygiene education must be specifically targeted at caregivers and volunteers involved in home-based care and must be one of the elements in training for home-based care • Currently, this is rarely done Source: Kamminga and Wegelin-Schuringa (2005), p. 13 16

Course 4 Unit 2 Part B: Institutional and policy aspects 17

Overlapping responsibilities For example: Ministry of Water, Ministry of Health, Ministry of Local Government – who is responsible for sanitation? 18

How is this for an ancient sanitation policy (from the bible)…? “Designate a place outside the camp where you can go to relieve yourself. As part of your equipment have something to dig with, and when you relieve yourself, dig a hole and cover up your excrement. For the LORD your God moves about in your camp … your camp must be holy, … “ - 5 th book of Moses 23: 1315 This quote stems from a Ph. D thesis of Ibiyemi Ilesanmi (2006) “Prefeasibility assessment of decentralised sanitation systems for new satellite settlements in Abuja, Nigeria”. TUHH (Hamburg-Harburg Technical University, Germany) 19

Purposes of awareness raising Awareness raising: § To elevate the level of knowledge § To enable stakeholders to participate in decision making Two kinds of communications: instructions on how to use the system, change behaviour… information or justification about why this is necessary, desirable, morally appropriate, etc. Source of this slide and next 2: Heeb et al. (2007) – they used the source UNESCO/IHP and GTZ (2006) to create these slides 20

Awareness raising for ecosan – why? Awareness for ecological sanitation is necessary: § concept is relatively unknown § not only to (potential) users, but also amongst engineers, planners, architects, decision makers, politicians, teachers, . . . Overall goal: spread knowledge among all stakeholders There is also a group of video clips produced by UNICEF which can be used for awareness raising for water, sanitation and hygiene education, you can view them here: ** 21

Course 4 Unit 2 Awareness raising – how? Strategy: § De-construct and re-construct a particular discourse about alternatives with new information, criteria, or factors with factors that weigh differently from the conventional approach § Information provided to the stakeholders should be tailored to their specific information needs Topics of the new discourse are e. g. : § participation better than top-down approaches § sanitation also for the poor – not only for the wealthy (“pro-poor approach”) § comparing the money invested in sanitation with the gains for the national economy 22

Awareness raising methods • It is important to tell people about ecosan even if they don’t know that they should know about it. Examples: – When you tell your friends, colleagues, parents, children about ecosan: they may be surprised but at least now they have heard about it • We need good tools and innovative methods, e. g. : n n n Television documentaries, video clips on www. youtube. com, interviews on the radio Books, pamphlets in local languages Eco-Solutions book from Paul Calvert (India) is a good example (see www. ecosolutions. org, and there also a few pages under Assigned Reading for this unit) – unfortunately, this book is not for free or available as soft copy 23

The importance of stakeholder involvement • Stakeholders are those groups of individuals or organisations who have an interest in the outcome of a particular process • Relevant stakeholders are those who should be involved in a particular process, as well as those who are mainly affected by it • A detailed stakeholder analysis should be carried out at the start of an ecosan project 24

Course 4 Unit 2 Possible types of stakeholders • Users of sanitation facilities • Users of ecosan products (recyclates) • CBOs and self-help groups (CBO = community-based organisation) • NGOs • Local authorities and governments • Service providers • Developers and investors • Financial institutions • Research and educational/training institutions Not all stakeholders will always need to participate in the programme – check on case-bycase basis 25 Source: UNESCO/IHP and GTZ (2006)

Example 1 for stakeholders: Lusaka peri-urban areas Stakeholder Roles of each stakeholder in provision of sanitation Enforcement of the roles Community Beneficiary of service Management of facility Through CBO Municipality Service provider or contracting service provision By-law development and enforcement Community health education (general gathering and in schools) Local government by-laws Government ministries Set policy and legislation Mobilise funding Regulate service provision Coordinate all stakeholders Through legislations protocols NGO Provides funding Capacity building of the community Organising user demand community involvement Through municipalities, government ministries Private Sector Construction of toilets Emptying of toilets Community social structures, CBO Source: MSc thesis Kennedy Mayumbelo (2006) See reference details in Course 4 Unit 1 26

Example 2 for stakeholders: faecal sludge management in Kumasi, Ghana Stakeholder category Stakeholder National government Government of Ghana Local government Kumasi Metropolitan Assembly Waste Management Department Regulator Environmental Protection Agency Donors Worldbank Research institutions International Water Management Institute (IWMI) – representation of West Africa Sandec Private sector Faecal sludge collection companies (17 in total) Dompoase faecal sludge treatment plant operator Manhole managers (informal operators providing a collection service to bucket latrine owners) Beneficiaries Households in various residential areas Farmers Recognised as potential stakeholders (they are not yet direct stakeholders) Source: MSc thesis Anselme Vodounhessi (2006) See reference details in Course 4 Unit 1 27

Example 3: stakeholder analysis and relevant communication strategies Stakeholders A. Investors, Regulators (state, communes, private) B. Planning (architects, engineers, project managers) C. Execution (sanitary firms) D. End user (individuals, families, farmers) Communication strategies • seminars • workshops • semi-structured interviews with key actors • Newsletter Eco. San. Lux • workshops, fairs • survey (end user attitude & behavior towards water) • Internet • Articles in national press Source: Paul Schosseler presentation at Aachen Advanced Sanitation conference (March 2007) 28 “Implementing sustainable sanitation concepts in Luxembourg – methodological approach and outcomes”– also on Extra Materials

Course 4 Unit 2 Participatory methods Health interventions may work better if social and cultural reasons for changing hygienic practices are emphasised rather than motivation building on health benefits Users should be given the opportunity to examine and identify their own problems and be offered a wide choice of sanitation systems Pilot projects can be useful within participatory methods § Remember: “seeing is believing” (or “seeing - and not smelling – is believing”) WHO (2006), Chapter 7, p. 112 (under Extra materials) 29

A participatory tool: PHAST = Participatory Hygiene and Sanitation Transformation (WHO 1998) PHAST tools are designed to aid discussion and decision making by using pictures and working in the third person § Pictures avoid issues around literacy and must depict the environment of the participants so that they can relate to it. PHAST is a tool that helps people participate in decision making in a non-threatening way. PHAST is a tool used inside the SARAR* philosophy It is important that PHAST is implemented correctly with trained facilitators - otherwise it risks the danger of not being very effective • SARAR = Self-esteem, associative strengths, resourcefulness, action-planning and responsibility • Source: Mayling Simpson-Hebert and Richard Holden on Ecosan. Res Discussion forum in March and May 2007 30

PHAST: Diarrheal Disease Transmission Routes “PHAST has an activity called Diarrheal Disease Transmission Routes whereby people learn how faeces from open defecation can spread through the environment to eventually infect another person. In our experience in several countries, this activity is quite impactful in helping people realize how faeces spread in the environment. Without actually mentioning germs, this activity gets the point across. Always someone in the group knows that most diarrheal diseases and worms are spread by faeces. ” Source: Mayling Simpson-Hebert on Ecosan. Res Discussion forum on 20 March 2007 31

Who is using PHAST (example in Ethiopia) “CRS is using PHAST in our projects in Ethiopia. It works well to introduce communities to ecosan. We are getting 100% coverage with Arbor Loos, mainly, although we offer choices including traditional pit latrines. In areas where we do PHAST in Ethiopia, we get 100% toilet coverage within a few months. This is led by the community group that went through the entire PHAST planning. We do help and support them with slabs and information about building a toilet correctly, and we have moved almost entirely to Arbor Loos and Fossa Alternas - ecological toilets -which also are very popular with farmers. We are really successful with PHAST. It is our key method for working with people and it works well. I know I am biased, as an author of PHAST, but the proof can be seen in community after community. ” Source: Mayling Simpson-Hebert on Ecosan. Res Discussion forum on 7 March 2007 and on 26 April 2007 32

Course 4 Unit 2 Who is using PHAST (example in South Africa) “PHAST is not a tool for teaching people. Once a decision has been made using the tools then it is acted on. Too often the tools are used again and again in a community and no effort is made to implement the decisions made, or worst of all, the facilitators disagree with the decisions made and implement what they want rendering the whole process irrelevant. The results can be interesting. On the sanitation ladder we had depicted the burying of human faeces just above open defecation in terms of hygienic practice. It was pointed out by community members that burying is a very safe practice, particularly in the rural areas where there is space, all a toilet structure gives you is more convenience. ” Source: Richard Holden on Ecosan. Res Discussion Forum on 3 Oct 2006 33

Planning for sanitation or ecosan projects Planning of councils § City council needs to evaluate whether to incorporate ecosan options in the existing system, or to maintain and extend an aging sewerage system A number of planning tools have been proposed: § Open Planning of Sanitation Systems (Ecosan. Res – Kvarnström and af Petersens (2004)) § Household Centred Environmental Sanitation Approach (HCES) – WSSCC/Eawag/Sandec § The ecosan project steps (UNESCO/IHP and GTZ, 2006, p. 20) 34

Required changes to institutions Municipalities may need to create new institutional arrangements, e. g. “Department of Sanitation and Solid Waste” instead of “Department of Water and Sewerage” § Excreta management may fit more logically together with solid waste management rather than with water supply 35

Training, promotion and education for ecosan • Training and education is needed at various levels: – Key local authorities – Builders – Staff responsible for collection, transport and secondary treatment – Household members • Visits to local demonstration sites • Promotion to the public and staff of urban services • Online ecosan courses • Leading by example (“practise what you preach”), e. g. people in prominent positions, staff members at sanitationrelated organisations MSc student Kennedy Mayumbelo speaking to residents in peri-urban settlements in Lusaka, Zambia (December 2005) 36

Course 4 Unit 2 Education for ecosan Ecosan projects are more complex than conventional sanitation systems, because: § they are trans-sectoral § they include topics ranging from (for example) calculating diameters of pipes to the analysis of cultural habits Ecosan awareness needs to be included in the curriculum of many different professions, e. g. engineers, planners, architects, health professionals, agricultural engineers 37

From Course 1 Unit 2 Remember the bubble diagram: Ecosan is an inter-disciplinary field . Logistics Civil/sanitary engineering Social and political sciences . Financing, management, business Ecological sanitation Integrated water resources management Agriculture, soil fertility Public health, hygiene education Policy, Advocacy, Communication Many different professions need education/training about ecosan 38

Codes and regulations There is a need for specific regulation of the use of human excreta and greywater, as inputs for agriculture Regulations should be based on technology-neutral functional criteria, stating the required performance of the sanitation system We now have the new WHO Guidelines for the safe use of wastewater, excreta and greywater (Volume 4: excreta and greywater use in agriculture) § See Chapter 10 on Policy Aspects § http: //www. who. int/water_sanitation_health/wastewater/gsuww/en/ § This chapter is also available under Extra Materials 39

The need for legislative aspects to be part of both pilot projects and capacity building activities Source: Johansson and Kvarnström (2005), p. 41 40

Course 4 Unit 2 Target areas for reviewing of relevant policy/legislation/regulation • Identification of opportunities for the promotion of ecological sanitation within existing regulatory framework • Lobbying for implementation and enforcement of existing legislation that is supportive to ecological sanitation • Proposal of reforms of parts of the legislation/regulation that have been identified as crucial to embrace ecological sanitation • Work with demand-driven approaches to sanitation Source: Johansson and Kvarnström (2005), p. 48 41

Course 4 Unit 2 Example for policy and legislation: South Africa “At present policy and legislation allow the use of urine diversion. The building standards do not preclude the use of UD but neither do they sanction it and the approach by municipalities tends to be unless it is sanctioned they will not permit it. (never mind they are breaking all the regulations by discharging below standard effluent into the environment) By getting all the elements of UD into the Standards we hope to overcome this argument and allow economics and water scarcity to do the rest. ” Source: Richard Holden, Ecosan. Res Discussion Forum on 10 August 2006 42

Example for a water and sanitation policy that includes ecosan in Tanum Municipality, Sweden Example section from this policy: § a) Sewerage within the area of duty for the municipality New detailed physical plans shall include a clause on urine to be discharged separately (urine diversion) in new houses and in houses that are being rehabilitated. The regulation requests that a connection to the communal water and sewage system shall be made with a separate urine pipe to the border of the premise. The municipality is responsible for the emptying, storing, and disposal of the urine. The house-owner pays the ordinary fees for connection and operation. § b) Sewerage outside the area of duty for the municipality In areas outside the area of duty for the municipality there are two alternatives: • b 1) The toilet is diverting the urine or is of the dry kind, while the remaining sewage is discharged to a private or cooperative unit for infiltration or soil-bed treatment. Source: http: //www. tanum. se/vanstermenykommun/miljo/toaletterochavlopp/waterandsanitationpolicy. 4. 8 fc 7 a 7104 a 93 e 5 f 2 e 8000636. html 43