Developing and Testing Strategies for Improving Cleanliness of Shared Sanitation in Low-Income Settlements of Kisumu, Kenya.

Sheillah Simiyu,Raphael Kweyu,Kwaku Adjei,Prince Antwi-Agyei

doi:10.4269/ajtmh.20-1634

Abstract

ABSTRACT.Sharing of sanitation is common in low-income settlements in Sub-Saharan Africa. However, shared (limited) sanitation facilities have been thought to pose health risks due to poor hygiene levels. Interventions to improve user behavior and cleanliness of shared sanitation are few, both in literature and in practice. This study details the codesign and testing of strategies to improve the cleanliness of shared sanitation facilities in low-income areas of Kisumu City in Kenya. The strategies included a cleaning plan, monitoring system, and discussions among users, and were codesigned through workshops with stakeholders and group discussions with landlords and tenants. These strategies were tested in 38 compound houses through the Trials of Improved Practices approach over a 5-month period. Field staff visited the compounds, observed the cleanliness of the shared toilets, and through discussions, encouraged users to develop a formal cleaning system and a monitoring plan. The discussions built social capital and collective action and facilitated uptake of the cleaning plan with notable improvements in cleanliness of shared toilets. The results support the acceptability of shared sanitation in low-income settlements, the importance of codesigning and coproducing solutions with users, and the need to evaluate the effects of these strategies on cleanliness of shared sanitation.

Highlights

It is estimated that between 2000 and 2017, the population using “limited” sanitation facilities increased from 5% to 8% globally.1 “Limited” sanitation refers to any basic sanitation facilities that are shared by two or more households
The strategies included a cleaning plan, monitoring system, and discussions among users, and were codesigned through workshops with stakeholders and group discussions with landlords and tenants. These strategies were tested in 38 compound houses through the Trials of Improved Practices approach over a 5-month period
Its use is widespread in sub-Saharan Africa where the population sharing sanitation facilities doubled between 2000 and 2017.1 Sharing is generally considered an interim solution, especially in low-income urban areas, which lack space for individual household sanitation facilities

Summary

Introduction

It is estimated that between 2000 and 2017, the population using “limited” sanitation facilities increased from 5% to 8% globally.1 “Limited” sanitation refers to any basic sanitation facilities that are shared by two or more households. Its use is widespread in sub-Saharan Africa where the population sharing sanitation facilities doubled between 2000 and 2017.1 Sharing is generally considered an interim solution, especially in low-income urban areas, which lack space for individual household sanitation facilities. Shared facilities are considered a low level of service because of health risks and human rights concerns.[1]. Health risks from sharing of sanitation facilities arise mainly because of the possibility of human contact with excreta due to poor hygiene levels. A number of studies have confirmed that shared sanitation facilities are a health risk as they often contain fecal matter due to poor user behavior, lack of cleaning, and a general lack of responsibility and initiative among users to clean the facilities.[2,3,4,5,6,7] Other studies, on the other hand, have suggested that shared toilets may not always contain fecal matter, and that they may be less contaminated, functional, and safer than individual household facilities.[8,9,10,11,12]

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Results

Discussion

Conclusion