Sustainability of community-led total sanitation outcomes: evidence from Ethiopia and Ghana
Int. j. hyg. environ. health
; 220(3)2017.
Artigo
em Inglês
| ODS
| ID: biblio-1025776
Biblioteca responsável:
BR1.1
ABSTRACT
We conducted a study to evaluate the sustainability of community-led total sanitation (CLTS) outcomes in Ethiopia and Ghana. Plan International, with local actors, implemented four CLTS interventions from 2012 to 2014 health extension worker-facilitated CLTS and teacher-facilitated CLTS in Ethiopia, and NGO-facilitated CLTS with and without training for natural leaders in Ghana. We previously evaluated these interventions using survey data collected immediately after implementation ended, and concluded that in Ethiopia health extension workers were more effective facilitators than teachers, and that in Ghana training natural leaders improved CLTS outcomes. For this study, we resurveyed 3831 households one year after implementation ended, and analyzed latrine use and quality to assess post-intervention changes in sanitation outcomes, to determine if our original conclusions were robust. In one of four interventions evaluated (health extension worker-facilitated CLTS in Ethiopia), there was an 8 percentage point increase in open defecation in the year after implementation ended, challenging our prior conclusion on their effectiveness. For the other three interventions, the initial decreases in open defecation of 824 percentage points were sustained, with no significant changes occurring in the year after implementation. On average, latrines in Ethiopia were lower quality than those in Ghana. In the year following implementation, forty-five percent of households in Ethiopia repaired or rebuilt latrines that had become unusable, while only 6% did in Ghana possibly due to higher latrine quality. Across all four interventions and three survey rounds, most latrines remained unimproved. Regardless of the intervention, households in villages higher latrine use were more likely to have sustained latrine use, which together with the high latrine repair rates indicates a potential social norm. There are few studies that revisit villages after an initial evaluation to assess sustainability of sanitation outcomes. This study provides new evidence that CLTS outcomes can be sustained in the presence of training provided to local actors, and strengthens previous recommendations that CLTS is not appropriate in all settings and should be combined with efforts to address barriers households face to building higher quality latrines.
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Contexto em Saúde:
ODS3 - Meta 3.9 Reduzir as mortes por produtos químicos y contaminação do ar, água e solo
/
Agenda de Saúde Sustentável para as Américas
/
ODS3 - Saúde e Bem-Estar
Problema de saúde:
Água, Saneamento e Higiene
/
Objetivo 7: Evidência e conhecimento em matéria de saúde
/
Meta 3.9: Reduzir o número de mortes por produtos químicos perigosos e contaminação do ar e água do solo
Base de dados:
ODS
Assunto principal:
Saneamento Rural
/
Educação em Saúde
/
Participação da Comunidade
Idioma:
Inglês
Revista:
Int. j. hyg. environ. health
Ano de publicação:
2017
Tipo de documento:
Artigo
Instituição/País de afiliação:
University of North Carolina at Chapel Hill/US