Changing Hygiene Habits in Rural Bolivia

Shifting from Open Defecation to Proper Use and Maintenance of Dry

Composting Latrines

Bolivian Reality Poorest country in South America

45% of 10 million people living in poverty (3x greater in rural areas)

Access to clean water (88%) and sanitation (54% urban, 27% rural)

Nutrition: 1 in 4 children has stunted growth (malnourished), rural children twice as likely to be malnourished

Life expectancy: 67 yrs. (vs. 75 yrs. for Latin America and the Carib., 2013)

Source: http://data.worldbank.org/country/bolivia

What is Etta Projects? Public health NGO founded in 2003

in Montero, Sta. Cruz, Bolivia. Office in USA (WA)

Program Areas:

Community health promoters

Ecological Dry Composting Latrines

Organic gardening, composting, recycling and trash separation in the home, school, and community

Solar powered water systems in remote communities, training of water committees.

EP Health Promoters practicing first aid skills

The Problem Many rural Bolivian communities have no access to sewage systems.

Families dig a hole for a “pit latrine” and build make-shift walls (plastic, bamboo, scrap metal) for privacy.

Open defecation in the fields or yard, around their homes.

Pit latrine in rural Bolivia.

The Problem Rainy season: 6 months of rain and flooding causes pit latrines to fill with water, bringing feces to the surface, spreading fecal matter throughout community.

Contamination: typhoid, E. Coli, cholera, dysentery…

Globally: 1.4 million children die each year from diseases caused by contact with fecal matter. That’s more than AIDS, malaria, and tuberculosis combined.

Hiking to remote communities to deliver workshops on hygiene and sanitation in Bolivia

Desired Outcomes Stop open defecation

Halt transmission of fecal-oral diseases

Change hygiene habits (hand-washing after toilet, before food prep and eating, after diaper changing )

Improve overall health for families

Secondary and Long Term Outcomes

Improved nutrition (for improved health and disease prevention) via family organic vegetable and fertilizer production.

Trained sanitation promoters for Education and M&E

Families and school children: increased awareness of water borne disease transmission, practice, habit change

Community leadership, advocacy, and project development for continued growth

EP staff leading community workshop on DCL use and maintenance

The Solution: Ecological Dry Composting Latrines

How does it work? • Separation of urine and feces • Urine and feces used for fertilizer • After each use, deposit dry material

and toilet paper into chamber (to dry out the feces)

• Stir the chamber 1x/week. • Clean the toilet 2x/week. • Family fills the chamber (6 mos. –

1 yr.) • Allow 6 mos. to decompose • Harvest and fertilize!

Benefits of DCL 2 sealed chambers= no contamination of water, soil, air.

Uses no water

After 6 months, harvest the fertilizer for the garden/fruit trees

Families no longer face: rain, insects, flies, mosquitoes, snakes, wild animals, and roaches when using the toilet.

Community Sanitation Promoter fills water bottle with bleach mixture for cleaning urine pipe.

Recipe for a Successful DCL Program

Community engagement in every step:

Request for project

Community needs assessment

Community meeting to discuss the project

Meeting with the municipal gov’t to request the project, formal contract

Community workshops: local coordination, attendance,

announcements, place, snacks, chairs, clean up.

Community members monitor and evaluate, solve problems

Local Health and Sanitation Promoters

Training of local sanitation promoters on use and maintenance of the latrines, proper hygiene and sanitation practices, disease prevention, trash separation (recycling and composting techniques), and use of the dry latrine compost on organic gardens.

Community Needs Assessment

Gather information on: family composition, current health status, defecation practices, hygiene practices, access to basic services, and skill set (assets-based community development approach).

Train local health promoters/leaders to conduct the interviews (already gained trust of community)

Gauge interest in community via asking questions. “Do you know what a dry latrine is? Would you use one? Are you interested in the project?”

Women from El Abra del Astillero participate in Community Monthly Water Meeting (2014)

Generating Interest and Demand •Define specific requirements for participation (economic contribution of each family, workshop attendance, and labor for construction). •Create a beneficiary list: Ask interested families to sign up and sign an agreement for required participation in three areas.

Community Health Promoters and EP Program Director armed with tools for the pilot latrine project.

Requirements for Participation

All family members must attend all workshops.

Implement a sanitation project in the home BEFORE approval for construction.

Carry construction materials to the house.

Help build the latrine.

Pay their portion of the latrine (US$75-$200, based on distance and local gov’t % support)

Information: Accessible, Interesting, Engaging!

Poverty, little formal education, work all day in the fields (sugar cane, rice, yucca)

Economically conservative and resistant to change

Requires: interactive, dynamic, participatory approach to the program. Learn names. Greet people. Ask about their families.

Plan workshops at night and on weekends to accommodate workday

Healthy snacks for those who arrive on time

Tactics

Use fear, disgust, and shame as motivating forces for habit change. Make sure the habit change is as easy as possible (access to water and soap for hand washing) . May require installation of a water faucet near the DCL. Include this in the program plan and budget.

Local sanitation and health promoters practice hand-washing with students

Shame Factor

Create large canvas map of the community, including each of the family’s homes.

Sanitation promoters score each family during their weekly home visits, including: presence of trash in the yard, farm animals roaming freely, flies in the latrine, wash stand for hand washing (with soap and water), clean toilet bowl, supply of dry material for covering up feces, etc.

Each house is color coded according to sanitation quality: Red: poor condition, sanitation problems. Yellow: needs improvement but not terrible. Green: Good sanitation conditions.

Map displayed at weekly workshops, for families to see clearly how they and their neighbors have scored. The top scoring families receive incentives (soap, toilet brushes, plastic buckets).

Use of Humanure

Harvesting the humanure: Disgust and fear factor. How to overcome? Organize community workshop to harvest a DCL together. Empty the soil and put on the garden. Ask the family to show results to the community at harvest time. Take soil sample to lab and show results (bacteria).

Urine is a great fertilizer! Ratio: 1:5 urine to water. Deters ants and other insects, contains Nitrogen, Phosphorus, and Potassium. How to overcome fear? Use urine on one half of garden and compare. Note difference in growth rate.

Elisabeth, a community health promoter, has 11 children. She harvested the fertilizer for her fruit trees.

Participation in the Construction Requirement: Families must pick up their building materials and help build the latrine. 1 member (male or female), 4 days. Learn: how each part functions, how to repair.

Celebrate!

Community inauguration of DCL’s

Graduation of Sanitation Promoters

Invite local authorities, mayor, Wat./san. dept. officials, Rotary Club members

Ribbon cutting

Speeches

Prizes for “best latrine”

Use M&E results

EP: 4th year DCL project.

Use M&E results to improve the construction model.

NGO should implement model! Build a DCL at the office, use it, understand it, clean it. Harvest it and use the fertilizer. Make improvements. Show it off to visitors.

Develop a manual for sanitation promoters training, for the community workshops, and school workshops. Make it available to all (literacy levels, pictures), to understand and copy.

Follow-Up Three year process

Continued M&E

Incentives: proper use and maintenance

Contests: prettiest, most improved, cleanest latrine, etc.

Support for sanitation promoters (dry goods baskets, sanitation tools, use and maintenance posters for each latrine).

Concrete vs. Conceptual Ex: “How many times have your

children suffered diarrhea this past month?”

How much time, money (on transportation, medical visits, and medicine), anxiety did she suffer each time a child became ill?

Explain: A DCL and hand-washing practice prevent diarrhea, save time, worry, and money.

Health, hygiene and sanitation: focus on concrete, current situations (vs. better quality of health in the future).

Personal Contact:

EP staff and sanitation promoters must increase their presence in the communities, by making home visits frequently, chatting with families, developing the relationship. This is essential for the long term success of the project.

Thank You! Obrigada Gracias Xie xie Danke Merci Grazie Arigato Takk

Salamat Po Asante

Kop Koon Ka’

Dona Pascuala, El Abra del Astillero, Solar Water Project beneficiary, EP 2014.