Dear all I think this discussion is crucial in all parts of the world today is especially with the great demographic changes taking place, thanks to better (and sometimes forces) migration.

In Cameroon it seems to be the norm for public especially government offices not to have functional toilet facilities. And where toilets function cleaning and maintenance is poor or absent.

This surely doesn't help people understand the need for proper sanitation especially if the attend health facilities.

It's common for women in England to avoid sitting down on public toilet seats - resulting in much wet underwear and splashing of seats, exacerbating the problem. If urine is indeed not a disease vector, then it's inconvenient behaviour to avoid an imaginary threat.

Dear Elisabeth and all,

I’d like to comment on your Frankfurt friend’s observation about office toilets used by Asian employees.

When we were conducting our UDT trials at our university in Sydney a couple of years ago (see Dena Fam’s contributions under UDT thread) we had many interesting discussions with our cleaning contractor and building manager. They reported that a staggering number of toilet seats across the university get broken and have to be replaced every week as a result of users climbing on to the pedestal toilets and squatting. This practice has increased as our student demography has changed with more international students from countries where squatting is the norm. Squatting on a pedestal toilet is wobbly and unstable - in one instance someone had fallen and been badly injured by breaking the ceramic pan.

In these sorts of situations, how feasible would it be to replace one or two pedestal toilets with squatting pans or otherwise making some squatting facilities available in office toilets?

There is also anecdotal evidence that women (in Australia at least) prefer not to sit on public toilets to urinate, but ‘hover’, contributing to spills and mess. Squatting toilets could offer an alternative - although the posture may be difficult for people who haven’t had practice

Regards,
Kumi

Dear Alexander and all,

Thanks a lot for raising this topic which we haven't had here before... and thanks for being honest about the bad state of toilets in some of your offices in East Africa.

We've often talked here on the forum about public or shared toilets and the challenges for keeping them clean and to achieve lasting behavior change. There are some good publications by the group of Hansi Mosler from EAWAG looking into what motivates people to change their behaviour or to not change it... See e.g. here for public toilets in Kampala:
forum.susana.org/forum/categories/71-beh...-measure-cleanliness
(Hansi has also put up all his publications here: www.eawag.ch/forschung/ess/gruppen/ehpsy/index_EN)

You mentioned dirty toilets or no toilets at all. I guess the behavior change aspects can be used to work on the dirty toilets but not on the "no toilet at all". I think in an office environment most organisations rely on some sort of cleaning staff to keep them clean? - I can imagine that "leading by example" by local health offices could be important when you're trying to spread hygiene messages to the community (but I haven't seen any research on that).

As an aside, a friend of mine worked for an office cleaning company for a while and the stories she told me about the state of those office toilets (in Frankfurt!) were truly shocking (you really wonder how fecal matter can be spread beyond the toilet seat... I guess with explosive diarrhea it might be possible). The floors of the building that she worked on differed a lot from one floor to another; she did say that the office toilets on floors with a lot of employees from Asian countries (in her specific case it was employees from India in particular) tended to be dirtier than on floors with employees mostly from Germany (sorry, this might sound racist or biassed but that's what she told me). I guess it all comes down to what people expect from their toilets and what they expect from their cleaning staff (i.e. if users are using the brush for a flush toilet to remove faecal matter from the toilet pedestal or not using it and rather expect the cleaning staff to clean up after them)...

There could be PhDs done on this subject, it's really quite fascinating.
As another aside: My observation here in Australia is that I've never seen anywhere better and cleaner public toilet facilities than what they have here. Public toilets are everywhere, always for free, and they are usually in excellent condition; users seem to have very good toilet behaviors and/or perhaps the cleaning staff is also very frequent and diligent (and possibly well paid?). Now I wonder how this was achieved in Australian society compared to e.g. German society. I wonder if someone has studied this before. I am digressing here, talking about public toilets whereas you talked about office toilets. But I just thought it could be helpful to point out differences in different countries and societies.

Have you been able to progress this issue (or at least awareness about it) within your organization, the Australian Red Cross, in the meantime? Has your own research turned up new findings and ideas about the impacts of this on the wider community?

Regards,
Elisabeth

Could it be anything about levels of intervention and/or supervision by outsiders? We have an expression in English about "seeing the wood for the trees", could it be something about local people not perceiving the seriousness of the sanitation problems in front of them (ie directly in their own clinic/health facility/office etc)?

Or could it just be that there is someone in some of the facilities who makes a point to make a noise about (takes responsibility for?) the sanitation situation in the clinics - and such a person does not exist in the other clinic for whatever reason..?

I would not find it surprising, if the number of users / facility was a significant factor in distinguishing institutions with well maintained vs. dirty facilities.
But my next question would be: why do some institutions provide enough facilities, and others dont?

joeturner wrote: I wonder why local Red Cross offices and government health offices have poor/dirty toilets. Is it just a low priority for the local health workers?

heh, very good question In our case it wasn't a Red Cross office before and simply one of the few buildings left in a totally destroyed area (the place where Typhoon Haiyan hit). Add to that the high number of volunteers we work with... basically we should have build a communal toilet block in front of the office when we arrived

I think this is a bit of a general problem, that facilities are often designed for the standard health workers in mind, but in fact you usually have a lot of visitors and so on for whom you would normally need several additional toilets to serve them but which is not that commonly included in the standard office building designs.

This is a crucial question in my point of view. Of course not all RC and gov. offices have poor toilets. It would really be interesting to identify the factors that distinguish those institutions that manage to have a good and clean sanitation facilities from those that don't.

I wonder why local Red Cross offices and government health offices have poor/dirty toilets. Is it just a low priority for the local health workers?

Nice to see more RC people joining, greetings for the GRC in the Philippines

This was actually one of the first things we had to improve here in our field offices as well, so that our volunteers can actually do as they say also. But it's a constant struggle, as the facilities we have are actually too few for the number of volunteers we cater to.

One of our program components is also to rehabilitate/build sanitation in basic health care centers, schools and pre-school day-care facilities. We feel this has an good impact as this way children are growing up being exposed to nicer/cleaner sanitation facilities and will aspire to better sanitation facilities in the future. However I am not aware of a detailed study measuring the impact or such. We have an ongoing simple & short term school based KAP study though, but I don't expect there to be much results in a few months.
However if such a detailed/scientific study exist it will be most likely for schools, maybe as part of a child led hygiene promotion campaign that expected to bring back increased hygienic behavior to the child's families as well.

However for cleanliness it is quite vital to have running water in these facilities, and currently we are also testing to have shower/bidet sprays (and corresponding tiled floors with drains) installed, but this is often a problem pressure wise.
But I am aware that the Philippines are a bit of a different setting in regards to the feasibility of running water in each bathroom...

Dear Alexander,

Toilets here in most government offices and schools are dirty. Sensitization and behavioral change,if done persistently, might help. Likewise, school children can effectively convey message to their respective communities.

Regards,

F H Mughal

We believe building and maintaining a large clean odor free UD ecosan toilet near the public school paved the way for other sanitation interventions to be received in our village in East Rwanda. We think the successful demonstration of a high profile attractive alternative made our friends much more receptive to the small UD household toilets we introduced later.