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From: Hygiene and sanitation – Footsteps 97

How behaviour change happens, the importance of handwashing and how to make soap

Clean water and safe sanitation improve everyone’s health and opportunities in life. When people have clean water and safe sanitation, many diseases are less easily spread. However, the World Health Organization has recorded that while nearly 750 million people in the world do not have access to clean water, 2.5 billion people lack access to safe sanitation.

Why is good sanitation so difficult to achieve?

At a national level, sanitation is rarely high on the political agenda. At community level, there can be a poor understanding of the link between safe sanitation and better health, and particularly of the benefits of disposing of human waste safely and ending open defecation. Even when people are aware that better sanitation leads to better health – perhaps they have been told by teachers at school or by community health workers – they can still take a long time to change their habits. As a result, in recent years there has been increasing research into what causes people to change their behaviour. This includes considering how health promoters can work more closely with communities and understand their needs and abilities better.

Those who have traditionally provided solutions to improve sanitation are also questioning the methods used in the past. In the 15 years since the Millennium Development Goals were agreed – including the specific target to improve sanitation – governments and organisations have been developing more successful approaches, which investigate what communities want before suggesting available technologies and solutions.

Should we focus on supply or demand?

Past methods were usually ‘supply-driven’. A supply-driven approach is one where a provider gives a solution. For example, latrine kits and services are donated by government or a non-governmental organisation (NGO), with little or no encouragement for the community to contribute anything. This can be suitable in an emergency context when immediate help is needed, for example in a camp. Otherwise it often leads to many of the latrines being misused or not used at all, because there was no consultation and agreement that they were appropriate. The latrines that are used may not be emptied or replaced when they are full, because there is a lack of technical knowledge and support, and a lack of any administrative or financial management.

Recent experience has found that ‘demand-led’ approaches are usually more successful, even if they start more slowly. This is because demand-led approaches empower communities by helping them to analyse their own behaviours and explore their needs and possible solutions. Many people, including poor people, are willing to pay for or contribute towards good sanitation that will satisfy their requirements if the technology is packaged and marketed well, and if there is a reliable and affordable supply of parts and services. To help this, the sanitation sector has developed ‘sanitation marketing’. This involves improving the sanitation market, starting by understanding people’s motivations for better sanitation and the barriers they face. A better supply of sanitation services can then be established to meet demand.

For example, a demand-led approach that includes sanitation marketing might involve:

A successful programme will stimulate the local economy and ensure solutions are sustainable.

This issue of Footsteps covers some of the challenges of demand-led approaches from the community facilitator’s point of view.

With thanks to Frank Greaves, Tearfund WASH Lead.

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