Latrine Utilisation – Changing
Attitudes and Behaviour
WASH Training
Factors affecting the use of latrines
and hand washing facilities
Latrines
The possession of an improved latrine, on its
own, will not halt the transmission of faeco-
orally transmitted diseases among the people
of your community.
For this to have an impact on health, the
people have to use their latrines and
handwashing facilities effectively.
Motivating people to change their
behaviour
Health education is frequently delivered by
someone lecturing about hygiene and
sanitation in health facilities and community
gatherings.
However, such an approach is not
recommended as the sole means to achieve
individual behaviour change.
Because human behaviour is influenced by the
surrounding environment and social context,
specific messages instead of universal messages
of hygiene and sanitation are more important.
Hygiene messages must be contextually and
culturally suitable, and comfortable, for your
community.
Community motivation
UNICEF uses the term Community Approaches to
Total Sanitation (CATS) to encompass a range of
different community-based sanitation programmes.
The aim of these approaches is total sanitation
which means the complete separation of wastes
from humans, i.e. no open defecation and 100% of
excreta to be hygienically contained. An important
goal for villages and other communities is to
achieve open defecation free (ODF) status.
summarises the key elements of CATS.
Essential elements of Community Approaches to Total Sanitation (CATS)
CATS aim to achieve 100% open defecation free
(ODF) communities through affordable,
appropriate, acceptable technology and
behaviour change.
CATS depend on broad engagement with diverse
members of the community, including
households, schools, health centres and
traditional leadership structures.
Communities lead the change process and use
their own capacities to attain their objectives.
Subsidies – whether funds, hardware or other
forms – should not be given directly to
households.
CATS support communities to determine for
themselves what design and materials work best for
sanitation infrastructure rather than imposing
standards.
CATS focus on building local capacities to enable
sustainability.
Government participation from the outset – at the
local and national levels – ensures the effectiveness
of CATS and the potential for scaling up.
CATS have the greatest impact when they integrate
hygiene promotion into programme design.
CATS are an entry point for social change and a
potential catalyst for wider community mobilisation
Two approaches to communal behaviour change
Participatory Hygiene and Sanitation
Transformation (PHAST) and Community-Led
Total Sanitation (CLTS) are among the CATS
techniques used to achieve total sanitation.
These methods introduce community
mobilisation and behaviour change as their
core principles to improve sanitation and
integrate hygienic practices.
• Traditional methods of sanitation and hygiene
promotion were teacher-driven, i.e. the
educator taught by lecture and the community
listened passively. CATS approaches are demand-
driven, community-led and emphasise the
sustainable use of user-friendly, affordable and
safe sanitation.
The following sections outline the basic principles
of PHAST and CLTS but to be a facilitator of these
techniques requires further study and training to
develop the skills required. Such training Might
be sought from NGOs involved in water and
sanitation (also known as WASH) projects.
Participatory Hygiene and Sanitation
Transformation (PHAST)
PHAST is a widely used community approach to
hygiene promotion. It uses participatory
techniques to promote good hygiene
behaviours, sanitation improvements and
community management of water supply and
sanitation facilities.
It is derived from a community appraisal method
of health practice that, in the process,
empowers community members (participants)
to be able to identify their community problems.
Case study:
PHAST in Ahmed Hodan district
Ahmed is a Health Extension Practitioner in Hodan. He
does not have adequate access to improved drinking
water. A baseline survey of giardiasis prevalence was
conducted and was found to be 25% among children
under 10 years old.
Ahmed had received training in the PHAST approach so
that she could train others.
he decided to put this training to good use and trained
nine village volunteers in hygiene promotion specifically
aimed at the prevention of giardiasis. These volunteers
then mobilised 2,500 community members, both adults
and children, in the Hodan.
During the training, the community members
identified the bad behaviour they were aware of
(such as open field defecation, disposal of child
faeces in open spaces, not washing hands after
visiting latrines and after cleaning a child’s
bottom).
The community members, with the help of the
nine village volunteers, planned to avoid those
bad practices and in contrast, adopt and sustain
good behaviour.
The training and community mobilisation
continued for one year.
People started to change their behaviour as a
result of increased awareness and a positive
attitude towards healthy behaviour.
Consequently, the prevalence of giardiasis
among children in the Hodan community was
reduced to 10%.
Hodan is now planning to achieve open
defecation free status within the coming 3–6
months. The achievement of Ahmed and the
volunteers was recognised and they took the
best practitioner prize of the year from the
hodan leader.
They are highly motivated to work more to
overcome the public health challenges in Hodan.
Community-Led Total Sanitation
(CLTS)
CLTS aims to bring community-wide
elimination of open defecation by raising
awareness and promoting affordable
technology options.
NGOs, multinational organisations and
government health programmes in many
countries in developing regions of the world
(including Somalia) are adopting this
approach. It has become the most successful
community approach to total sanitation.
Latrine utilisation monitoring and
evaluation
Any programme that is promoting behaviour
change needs to have a process for assessing
how effective it is – in other words, a
monitoring and evaluation process. Latrine
utilisation promotion and other WASH
projects therefore need to include monitoring
and evaluation activities.
This means setting specific, measurable and
achievable objectives, and clearly stating the
monitoring activities and indicators to be
used.
There is an important preliminary step which is
to gather baseline data of the situation before
the intervention for comparison with the data
gathered by the monitoring activities. The same
indicators should be used both before and after
so you can compare like with like. Important
measurable indicators for latrine use and
handwashing include:
no visible human excreta in likely sites
percentage of households that have a latrine and
which is seen to be in use
percentage of latrines with no faeces and urine
soiling on walls and floors
presence of handwashing facility and water near the
latrine
presence of soap, ash or other cleaning agent near
latrine
percentage of communities/villages certified as ODF
percentage of households that have upgraded their
latrine to an improved system
percentage of households with clean compounds
without any excreta.
Case Study
Imagine a small village of about 20 households
where open defecation is the normal practice.
You have visited the village and, from discussions
with the people there, you know that most of
them are ignorant of the importance of
sanitation.
They say to you that they have always lived in this
way and so did their parents and grandparents
before them.
They are reluctant to change their habits. What
methods would you consider to motivate change
in their behaviour?
Answer
The people in this village are not aware of the importance
of sanitation so you would need to find ways to educate
them about the connection between hygiene and
sanitation, and their health.
You could ask to speak to a community meeting but this
approach may not be successful if you simply stand and
talk to the villagers.
You could suggest a coffee ceremony or other social
gathering as a means to initiate discussion about the
issue and to encourage people to attend.
You could consider individual house-to-house visits to
have more private conversations with individuals and
families about hygiene and sanitation.
Individual visits may help you identify potential model
households that you could also use in your campaign.
With the cooperation of the community, and if
you had had the appropriate training or could
call on the support of others who had, you may
also consider using a CLTS approach.
You may have to adopt several of these
approaches and be flexible according to the
responses you get from the community.
You should also recognise that it may take time to
convince the people of the benefit of change.
