Hi Elizabeth,

Below are my answers to your questions.

1. Are the approaches that lead to behavior change the same as those used in sanitation marketing?

Yes, the approaches that lead to behavior change are the same used in sanitation marketing. The aspect that is a bit different in the approach we tested in Burundi is door-to-door visits to households where we did not test mass communication through theater. But in general we stress on the positive impacts of sanitation on human health, water quality, and other aspects related to social standing and pride. Another motivation is also the possibility to use whatever comes out of a latrine in agriculture (feces and urines as natural fertilizers) but under certain conditions and with proper disposal.

2. Sanitation behavior change interventions consisted of a combination of initiatives as follow: [...] Awareness to households through theater as a mass communication mean + trainings to local construction workers. This makes it sound like a sanitation behavior change intervention can consist of a sanitation marketing approach, i.e. street theatre? Is one the tool to achieve the other? (i.e. sanitation markketing is the tool to achieve behavior change?) How do you see this? I find it confusing.

This means that one approach we tested is to create the enabling environment by training construction workers, etc. then doing awareness through theater plays in a public place where people can have easy and free access to learn about sanitation in a fun way. In this case you can consider that sanitation marketing is used to achieve behavior change. However, you have to note that this approach proved not to be very efficient because a lot of information is required before the play to inform people and proper monitoring and follow-up is required after the play. This could eventually be done at a small scale, but not at a large scale/national level.

3.The average cost of the first two types varies between 12 and 15 euros. (ecosan latrine versus simple pit latrine).

The average cost of latrines is very low because it is all made with local material (slab made of clay, cow manure and sand - superstructure made of wood and banana leaves, etc.). However, given the crisis and the current situation in Burundi, I am not sure if these prices are still applicable. Costs might have to be reviewed and adjusted.
Unfortunately, I cannot share documents, this requires the approval of the ministry of public health (and all docs are in french). I have however attached a document that provides some info about this work. I hope this helps.

Regards,
Nabil.

Dear Nabil,

Your post is very interesting and relates to a question I asked here: forum.susana.org/forum/categories/225-th...e-sector-roles#15711

The question in my mind is:

Are the approaches that lead to behavior change the same as those used in sanitation marketing?

Is it perhaps even just a different name for the same thing?

In your post you said:

Sanitation behavior change interventions consisted of a combination of initiatives as follow:
[...]
3. Awareness to households through theater as a mass communication mean + trainings to local construction workers.

This makes it sound like a sanitation behavior change intervention can consist of a sanitation marketing approach, i.e. street theatre? Is one the tool to achieve the other? (i.e. sanitation markketing is the tool to achieve behavior change?) How do you see this? I find it confusing.

Also in your post you said that:

The average cost of the first two types varies between 12 and 15 euros. (ecosan latrine versus simple pit latrine)

This is interesting as we normally hear that UDDTs are much more expensive than normal pit latrines. Could you please expand on this, perhaps by attaching a document that has photos of the three types of toilets that you promoted and a cost break-down for each?

Kind regards,
Elisabeth

Hi Nabil,

Many thanks for this posting and for sharing your experience from Burundi - your initial analysis of the different approaches adopted is really helpful. It highlights just how important the context is and the economic constraints people face even if the incentives for change are demonstrated.

Theme 2 will fully begin next week, so we can use your post to stimulate discussion on the likelihood of sustained behaviour change and the challenges we face in reaching poor communities in rural areas - which becomes ever more pertinent as the SDGs rightly compel us towards universal access for all.

Thanks again for the contribution, Tracey

(Note by moderator: this post was originally in this thread: forum.susana.org/forum/categories/210-th...rogramming-for-scale)

Dear Tracey,

Thank you for initiating this discussion. I would like to contribute by briefly describing the work we are currently undertaking in rural areas in Burundi to improve access to sanitation and improve drinking water quality at the household level. Our work fits mostly under theme 2 of this discussion.

We started our activities end of 2012 with a baseline study covering around 750 households where results were as follow:
- Most households (around 97%) have access to a latrine, but only 11% of these latrines are in line with the criteria for appropriate latrines in Burundi. This was in line with the access rate of 14% in rural areas determined through a national survey in Burundi.
- Water quality tests showed that 58% of samples taken from sources and 78% of samples taken from households are contaminated with fecal coliforms.
- Questionnaires with households showed a correlation between these results and poverty (average household income of 25euros per month) and lack of awareness.

Based on these results, behavior change interventions were designed to improve access to sanitation and water quality at the household level. These interventions were designed to target mainly psychological factors, and were tested in the same areas covered by the baseline survey. Two evaluation surveys are planned to measure the impact of these interventions, one short-term (one month after implementing the intervention) and medium-term (6 months after implementing the intervention). These evaluation surveys allow also determining scaling-up potentials for one or more interventions.

Sanitation behavior change interventions consisted of a combination of initiatives as follow:
1. Awareness sessions to households + trainings to local construction workers + in-kind subsidies up to 50% of the cost of a latrine.
2. Awareness sessions to households + trainings to local construction workers + assistance in household family planning to save enough money for the construction of a latrine.
3. Awareness to households through theater as a mass communication mean + trainings to local construction workers.

3 types of latrines were proposed to households:
1. EcoSan latrine constructed with local materials (wood and banana leafs), a water proof roof and a concrete or traditional slap (cow manure mixed with sand and clay) allowing the separation between urine and feces.
2. Simple improved latrine constructed with local materials with a concrete or traditional slap (cow manure mixed with sand and clay).
3. Improved latrine with a reinforced concrete slap.

The average cost of the first two types varies between 12 and 15 euros.

Water behavior change interventions consisted of a combination of initiatives as follow:
1. Awareness sessions to households + trainings to local plumbers to produce appropriate storage containers at the household level (with a tap or a rubber pipe to avoid direct contact of users, and with a cover).
2. Awareness sessions to households + promotion of the use of chlorine for water treatment at the household level.
3. Awareness sessions to households + trainings to local plumbers to produce appropriate storage containers at the household level (with a tap or a rubber pipe to avoid direct contact with users, and with a cover) + promotion of the use of chlorine for water treatment at the household level.

Many other activities were undertaken to create an enabling environment for the success of these interventions such as training of health promoters to conduct awareness sessions, training of pharmacists to produce chlorine using WATA kits, training of latrine construction workers and plumbers, building of demonstration latrines in pilot areas, training for the proper use of urine and feces as natural fertilizers, introduction of proper construction materials stock management techniques, installation of solar panels to generate power necessary for chlorine production, etc.

The short-term evaluation of sanitation interventions showed the following preliminary results:
1. Theater as a mean of mass communication did not have a major impact on access to sanitation, therefore has a limited potential without consistent follow-up.
2. Awareness using local agents is an effective technique, but proper follow-up and monitoring from local, provincial and central sanitary authorities is necessary. The 1st awareness sessions to households were more effective than follow-up sessions planned according to the approach proposed.
3. The favorite type of latrine was the low-cost EcoSan latrine due to the possibility of using urine and feces as natural fertilizers in rural areas of Burundi were most of our pilot households are very poor farmers.
4. Although subsidies contributed to an improvement of the access rate, this approach was not as effective as awareness combined with assistance in household financial planning to save for the construction of a latrine. Many households who received construction materials did not necessarily use them for the construction of a latrine.
5. At the time of evaluation, many household have already started constructing or rehabilitating their latrines, but construction works have not been completed yet. Exact figures on access rates would be available during the second planned evaluation survey.
6. Interviews with households showed that even those who have not started taking action yet became more aware of the importance of a latrine and its use and the health impacts it generates.
7. One major problem remains the lack of construction materials in general in Burundi, and especially in rural areas where very simple materials such as cement, wood, funnels, rubber pipes, etc. are not available, and prices are very high.
8. Construction workers capacities are in general very low.
9. Poverty remains a major challenge.

Water treatment interventions with chorine have not been tested yet due to many technical problems and the current security situation in Burundi. The evaluation of the awareness sessions to promote the use of special water containers showed the following:
1. Households’ awareness increased following the sessions and they are more sensitive to water-born diseases.
2. The price of the storage container (around 8 euros for a 10-liter container) is a major challenge to households. This explains that none of the households bought a container following the intervention in the concerned pilot area.

Finally, it is to be noted that the scaling-up potential of these interventions remains to be analyzed following the second evaluation planned and the availability of more information given the existing capacities in a country such as Burundi, and the cost required for the implementation of such an approach.

All activities described above were undertaken by the GIZ water program in Burundi in collaboration with EAWAG.

I hope this gives a general overview about our activities and could be useful to others.

Best,
Nabil.