The Impact of Pro-Poor Sanitation Subsidies in Open Defecation-Free Communities: A Randomized, Controlled Trial in Rural Ghana

Behaviour change interventions to promote household connectivity to sewer: a scoping review

Households without access to a functioning and well-managed sanitation system produce untreated faecal waste. While connecting households to sewers is ideal in densely populated low-income areas, the connection rates often remain low. Most interventions to increase connectivity focused on addressing financial, social, and legal barriers; there is limited evidence on the effectiveness of behaviour change interventions in promoting sewer connections. Thus, we aim to understand the effectiveness of behaviour change interventions in increasing the uptake of sewer connections. We developed a review protocol with key search terms relating to households, sewers, behaviour change interventions, promotion, and effectiveness. We aimed to identify both the types of interventions deployed and their impact on increasing household sewer connections. Eleven articles met the eligibility criteria and were included in the review. Findings indicate that changes in rates of connection were associated with interventions that included a blend of indirect financial subsidy in the form of a free connection and community-engagement activities. There was limited evidence that behaviour change campaigns without financial incentives lead to changes in sewer connection rates. A multi-component package involving financial subsidies with community engagement is likely to improve the sewer connection rate.

To use financial incentives or not? Insights from experiments in encouraging sanitation investments in four countries

We conduct a systematic re-analysis of intervention-based studies that promote hygienic latrines and evaluate via experimental methods. We impose systematic inclusion criteria to identify such studies and compile their microdata to harmonize outcome measures, covariates, and estimands across studies. We then re-analyze their data to report metrics that are consistently defined and measured across studies. We compare the relative effectiveness of different classes of interventions implemented in overlapping ways across four countries: community-level demand encouragement, sanitation subsidies, product information campaigns, and microcredit to finance product purchases. In the sample of studies meeting our inclusion criteria, interventions that offer financial benefits generally outperform information and education campaigns in increasing adoption of improved sanitation. Contrary to a policy concern about sustainability, financial incentives do not undermine usage of adopted latrines. Effects vary by share of women in the household, in both positive and negative directions, and differ little by poverty status.

Barriers to transition to resource-oriented sanitation in rural Ethiopia

Recycling excreta resources through resource-oriented toilet systems (ROTS) holds transformative potential, yet adoption remains limited, especially where benefits could be high. This study aims to understand constraints hindering the adoption of ROTS in one such area in Ethiopia. Based on a survey among 476 households comprising 2393 individuals, we examine the plans to use ROTS and willingness to pay for ROTS and apply structural equation modelling to analyze the drivers of these two outcomes while comparing the explanative power of the extended technology acceptance model, extended theory of planned behaviour, and their combined model. While 40% of households expressed a plan to use ROTS and 20% reported willingness to pay for a subsidized ROTS with a biogas unit, merely 7% revealed both the plan to use and sufficient willingness to pay, highlighting the need to target both these complementary outcomes concurrently. The theory of planned behaviour showed the best explanative power, also revealing that these two outcomes are influenced by partly distinct sets of factors. Findings imply that common efforts to ease objective constraints through subsidies, which incentivize willingness to pay, are necessary but not sufficient for facilitating the adoption of ROTS. To simultaneously enhance intentions to use, it is also recommended to target psychosocial drivers, such as perceived behavioural control and perceived community support, through awareness creation, behaviour change activities, and community engagement techniques.

Determinants of Open Defecation Among Rural Women in Ghana: Analysis of Demographic and Health Surveys

Open defecation continuously remains a major global sanitation challenge, contributing to an estimated 1.6 million deaths per year. Ghana ranks second in Africa for open defecation and had the fourth-lowest sanitation coverage in 2010. Evidence indicates that about 32% of the rural Ghanaian population still practice open defecation due to lack of access to basic sanitation facilities, drifting the country from achieving universal access to sanitation by 2030. Women, particularly those in rural areas, are disproportionately affected by open defecation, facing heightened health risks, harassment, and a loss of dignity. Even though previous studies on open defecation in Ghana exist, they lack national representation and neglect women in rural residents who are disproportionally affected by the repercussions of open defecation. Examining that rural women will contribute to heightening their own vulnerability to health risks by practising open defecation is essential to bridging the literature gap on open defecation practices among rural women. The study investigated determinants of open defecation among rural women in Ghana using data from the female files of the 2003, 2008 and 2014 Demographic and Health Surveys (DHS). A total of 4,284 rural women with complete information on variables of interest were included in the study. The outcome variable was 'open defecation', whilst 14 key explanatory variables (e.g., age, education, wealth status, among others) were used. Two logistic regression models were built, and the outputs were reported in odds ratio. Descriptively, 42 in every 100 women aged 15 to 49 practiced open defecation (n = 1811, 95% CI = 49-52). Open defecation (OD) significantly correlated with educational attainment, wealth status, religion, access to mass media, partner's education, and zone of residence. The likelihood of practicing open defecation reduced among those with formal education [aOR = 0.69, CI = 0.56-0.85], those whose partners had formal education [aOR = 0.64, CI = 0.52-0.80], women in the rich wealth quintile [aOR = 0.12, CI = 0.07-0.20], the traditionalist [aOR = 0.33, CI = 0.19-0.57], and those who had access to mass media [aOR = 0.70, CI = 0.57-0.85]. Residents in the Savannah zone had higher odds of openly defecating [aOR = 21.06, CI = 15.97-27.77]. The prevalence of open defecation is disproportionately pro-poor, which indicates that impoverished rural women are more likely to perform it. Public health initiatives should aim to close the rich-poor divide in OD practice among rural women.

Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling

Improved sanitation provides many benefits to human health and well-being and is integral to achieving Sustainable Development Goal Six. However, many nations, including most of sub-Saharan Africa, are not on track to meeting sanitation targets. Recognizing the inherent complexity of environmental health, we used systems thinking to study sanitation sustainability in Uganda. Our study participants, 37 sanitation actors in three rural districts, were engaged in interviews, group model building workshops, and a survey. The resulting model was parametrized and calibrated using publicly available data and data collected through the Uganda Sanitation for Health Activity. Our simulations revealed slippage from improved sanitation in all study districts, a behavior reflected in real interventions. This implies that systemic changes-changes to the rules and relationships in the system-may be required to improve sanitation outcomes in this context. Adding reinforcing feedback targeting households' perceived value of sanitation yielded promising simulation results. We conclude with the following general recommendations for those designing sanitation policies or interventions: (1) conceptualize sanitation systems in terms of reinforcing and balancing feedback, (2) consider using participatory and simulation modeling to build confidence in these conceptual models, and (3) design many experiments (e.g., simulation scenarios) to test and improve understanding.

Prevalence of Gastrointestinal Parasites in Pigs: A Preliminary Study in Tolon and Kumbungu Districts, Ghana

Pigs are important livestock that contribute to the economy and food security of Ghana, but the productivity of the sector is hindered by factors such as parasitic disease infections. Here, we detected the prevalence and polyparasitism of gastrointestinal parasites in pigs from selected farms in the Tolon and Kumbungu districts. Faeces of the animals were screened for parasite eggs using the sedimentation and flotation methods. From 56 pigs screened, 91.1% (CI = 95%; χ2 = 0.212) of them had parasitic infections, and affected pigs harboured 1-5 distinct parasites with the most occurring being Strongyloides ransomi (46.43%). Other parasites identified included Hyostrongylusrubidus, Ascaris suum, Trichuris suis, Physocephalus sexalatus, and Coccidia, among others. Parasitism was more frequent in pigs under 2 years (94%) than older ones (66.67%). The high prevalence of GI parasites was attributed to poor husbandry practices and inadequate of veterinary care for the animals. The situation can be improved by farmer education on good husbandry practices and regular deworming of pigs.

Sustainability of facilities built under the Community-Led Total Sanitation (CLTS) implementation: Moving from basic to safe facilities on the sanitation ladder

In the context of monitoring progress towards SDG target 6.2, a household is counted to have access to sanitation if it uses at least basic sanitation services. Several approaches have been employed to help rural communities to climb up the sanitation ladder such as Community-led Total Sanitation (CLTS), whose primary target is to end open defecation through behavior change. CLTS does not subsidize sanitation facilities, but let households build their own facilities. The types and sustainability of facilities when construction is entrusted to households without guidelines remain understudied. The contribution of CLTS in achieving SDG6.2 also have not been studied. This paper addresses these gaps. Conducted in the province of Sissili in Burkina Faso, our study involved interviewing CLTS implementers, government officials, and community stakeholders. Coupled with household surveys, the data was analyzed using SPSS and Excel software. Findings indicate that CLTS succeeded in motivating households to build latrines hence escalating latrine coverage from 29.51% in 2016 (pre-CLTS) to 90.44% in 2020 (post-CLTS) in the province. However, 97.53% of latrines built were unimproved pit latrines with superstructures and without/with wooden or clay slabs and no roof, of which 19.76% collapsed during the rainy season. During this period, sanitation access rate rose from 11.9% to 17.00%. The study has therefore revealed that CLTS significantly elevates latrine coverage, yet it does not guarantee a proportional rise in sanitation access. This discrepancy results from the type of technologies generated by CLTS, which are not considered in calculating the sanitation access rate due to their unimproved nature. Consequently, further exploration of social approaches is essential, amalgamating technical and engineering aspects. Beyond socio-economic considerations, the sustainability of CLTS and the achievement of access to adequate and safe sanitation also rely on the robustness and resilience of the implemented facilities.