This chapter is about helping the community improve their hygiene, plan and build latrines, and build awareness and action against AIDS.

Transcription

1 This chapter is about helping the community improve their hygiene, plan and build latrines, and build awareness and action against AIDS. CHAPTER 7 Hygiene, Sanitation, & HIV/AIDS 55

2 Introduction We have been talking a lot about water supply and the development of community management. This section will look at another RWSSP component - health promotion - how to facilitate discussion, planning, and action on Hygiene, Sanitation, and AIDS. RWSSP is more than a water project. It is a health improvement project, involving water supply, hygiene, sanitation, and HIV/AIDS. Water supply alone will not improve health. Changes in all four components are needed to improve health. A new water supply on its own will produce some health benefits like reducing diarrhoea. However, more benefits can be obtained if the new water facilities are combined with the construction of latrines, adopting new hygiene practices (eg safe use of water, handwashing) and practical action against AIDS. Health promotion will be part of your work in the community. You will integrate these activities with the development of water supply and community management. Definitions What is Sanitation? Sanitation is a process where people demand, develop, and sustain a hygienic and healthy environment for themselves by erecting barriers to prevent transmission of disease. It includes development of facilities such as latrines, handwashing facilities, etc What is Hygiene? Hygiene is the practice of keeping oneself and one s surroundings clean in order to prevent illness or the spread of disease. It includes proper use of water and sanitation facilities and practices to prevent the transmission of diseases, eg water and sanitation related diseases. These practices include using safe water (not contaminated sources) and keeping it clean; using latrines; washing hands at critical times. This chapter will look at: 1 Definitions 2 Existing Situation 3 Goals & Indicators 4 Old Approach to Health Promotion 5 New Approach to Health Promotion 6 WASH Approach 7 Animators 7 Project Cycle 7 Behaviour Change 8 Sanitation 9 HIV/AIDS What is AIDS? HIV? AIDS (Acquired Immune Deficiency Syndrome) is a set of diseases, which are caused by a virus which affects the body s immune system, making it liable to infections to which it would normally be resistant. This virus is known as the Human Immunodeficiency Virus (HIV). 56

3 Existing Situation Sanitation Over 80% of households have pit latrines but many were built for the wrong reasons - in response to force or fines. As a result the latrines are poorly built, maintained and used. They are unsafe to use. In some areas latrines have collapsed due to high water tables. Technologies to improve latrines, eg sanplats or materials to line pits, are generally not known in rural areas. Women have a bigger demand for latrines than men, due to concerns about privacy and safety. Men have less problem using the bush so they have less interest in using latrines. Women depend on men to finance latrines, dig pits, and build the roof. Hygiene There is little demand for hygiene - people don t why they should adopt new hygiene practices. Knowledge on hygiene is high but practice is poor. People know basic messages on hygiene but lack resources to apply them eg buy soap or improve toilets. Washing hands before eating is common (over 80%) but washing at other critical times is relatively uncommon (after defecation - 33%; before preparing food - 17%) Washing hands after cleaning a child s bottom or after using the latrine are viewed as difficult because there is often not enough water available in the house. Another big obstacle to improved hygiene is women s heavy workload. Women are so busy they don t have time to do things hygienically. Men s control over household money blocks hygiene practices at home. I didn t know HIV/AIDS was so serious. HIV/AIDS Knowledge, attitudes and practice related to HIV and AIDS is generally low. Many people don t see themselves at risk of HIV infection or see the seriousness of the HIV epidemic. They don t feel personally involved. They see it as somebody else s problem (eg people living in town or commercial sex workers), so they have no commitment to changing their own behaviour. Other people are aware of the risks but feel powerless to do anything. They feel dependent on government or health officials to make changes and can do nothing themselves to prevent, control, or live with AIDS. Young women are particularly at risk, due to poverty and limited control over sexual decision-making. Poverty forces some young women into commercial sex. Other factors contribute to the spread of HIV including: excessive drinking, multiple sexual partners, and customs (eg widow inheritance, polygamy, circumcision) People don t know their HIV status and are reluctant to be tested. People find it difficult to talk about AIDS, since it is associated with immoral sexual behaviour. It is also difficult for parents to talk with children about AIDS. There is lots of denial and stigma towards people with HIV/AIDS. People point fingers at others and fail to see that we are all at risk. Women in households affected by AIDS have a big workload, including increased water collection (because of high diarrhoea) and increased home care for HIV affected people. 57

4 Goals and Indicators What are the goals & indicators for improvements in hygiene, sanitation, and HIV/AIDS? INDIVIDUAL HYGIENE HABITS: Individuals and households are improving their hygiene habits: Using new water facilities on a regular basis Avoiding the use of surface water for drinking and bathing Washing hands with soap/ash before meals and after defecation Cleaning fetching containers and covering storage containers Using a clean cup or calabash in fetching water from containers COMMUNITY ACTION: Water point, compounds, and the environment are regularly cleaned. SITE MAINTENANCE: Water point is clean and well maintained: Regular cleaning and weeding of area around facilities Draining water away from water point Repairing cracks in cement structures SANITATION: Latrines are properly constructed, maintained and used: Number of completed latrines Number constructed without subsidy More people using latrines Clean condition of latrines and absence of anal cleaning materials Water and soap/ash at latrine HIV/AIDS: Increased openness to talking about sex and HIV/AIDS Increased awareness that HIV exists, is dangerous, and people are at risk of getting it. Feeling that people are not powerless, that they can do something to reduce risk of HIV. Agreement among peer group members of coping strategies to minimise risk of HIV/AIDS. Recognition of the blocks to adopting safe sex practices - and strategies to overcome Community meetings to discuss HIV/AIDS and discuss/plan what can be done Faith groups, churches, and mosques advocate HIV/AIDS awareness/action to believers Community agreement to stop or lobby against practices which increase risk of HIV/AIDS eg all night dances or excessive use of alcohol. Adoption of positive attitudes towards People Living with AIDS Community agreement to support AIDS affected households eg waiving water fees Openness to getting tested for HIV Increased access to condoms at community level Decrease in HIV/AIDS cases and STD cases 58

5 Old Approach to Health Promotion We have bombarded rural communities with health messages for a long time. As a result they know the messages, and sing all the songs, but they don't practice these behaviours. WHY? Community members already have considerable knowledge about health messages, but do not apply what they know in practice - They know that water from rivers and dugouts can make them sick, but many continue to use these sources in the wet season. They know it is important to wash hands before eating and after defecation, but they don't do it. They know faeces can cause disease and should be buried, but few dispose of their children's faeces. Why Didn't the Old Approach Work? The old approach was a message delivery approach. Field workers told villagers what to do through talks. They talked and talked and delivered lots of information, but allowed little time for discussion. But the talks didn't work. Villagers had to listen, swallow the ideas, and put them into practice - and their own ideas were ignored. Villagers felt treated like "empty pots" into which the field workers poured information. It made them feel ignorant. They had no chance to talk about the difficulties they might have in adopting the messages. Messages made change look simple, but changing behaviour is not easy. Messages don t talk about the problems people face in trying to put them into practice. People often have very good reasons for not adopting the messages. For example telling a woman to "drink pump water" sounds simple, but it is hard for her to apply this message in the rainy season when she is so overworked she is forced to use water from a nearby dugout. She knows the water is dirty and can make her family sick, but because of workload she has no time to walk to the pump and wait in line. Unless she finds a solution to the workload problem, she won't be able to "drink pump water" and stay healthy. The health topics were imposed on the community. The health workers decided that villagers had a health problem - and made no effort to find out what the villagers were really concerned about. As a result, the villagers were not really interested in the messages. The messages had no meaning to their lives. They were simply a set of rules to be blindly followed, not actions that they had planned themselves. Villagers knew the messages but there was no commitment to these actions, so villagers didn't do what they were told. Knowing facts does not change behaviour. People need more than information. They need to discuss and think about it. How will it help them? How can they do it? We can't expect people to follow our ideas. The process of adopting new ideas is not a passive process of swallowing other people's ideas. It is an active process involving problem-solving, decision-making, and action. People need to discuss these ideas with others and get approval and support for change. 59

6 New Approach to Health Promotion Integrated Approach: In the old approach field workers held separate meetings on H&S with no link to water supply. In the new approach you will bring Hygiene, Sanitation and AIDS into all discussions. For example you will ask questions - "What are the health risks with the old water sources and health benefits with new facilities? What water fee exemptions should be given to AIDS affected households?" At each phase you will bring H&S&A into the discussion, giving it equal attention to water supply. Build a Demand. One aim will be to get community members to see H&S&A as a serious issue in their lives - something they want to take action on. At present they see H&S as something imposed by outsiders and not as a survival need like water; and they see AIDS as someone else s problem or something they are powerless to deal with. There is no sense of responsibility to H&S, or in the case of AIDS a sense that they can actually do something to stop HIV infection. To build commitment and a sense that they can do something will require a new approach. Stop Telling Villagers What To Do: We need to stop talking and talking and delivering messages. Instead we need to ask questions and facilitate discussion - and change our attitudes towards villagers. We need to stop thinking of villagers as "those ignorant people who are not practising what we preach!!" We need to accept that villagers have ideas and experience: they already know many hygiene facts and are capable of working out practical solutions if we give them a chance. From Knowing to DOING: The old approach focused on giving information. It assumed that knowledge alone would bring about change. The new approach will focus on knowing and DOING - helping people find solutions which are do-able - practical, realistic, affordable. It will not only raise awareness; it will also help people think through the practical steps to take action, including constraints which are blocking action (eg cost of soap or latrine building materials, workload constraints, etc.) LISTEN! Participatory Methods. The old approach used 1-way communication. The new approach will use a participatory process of discussion, problem-solving, and action planning. The community will identify water, sanitation, and AIDS related health problems; then they will work out solutions and develop action plans. The aim will be to get the community to decide themselves what they want to do. They will discuss why poor faeces disposal or certain sexual behaviours are risky to their health, how this affects their lives, and what they can do practically to minimise these risks. Since they are doing the thinking and deciding and planning, they will be more committed to taking serious action. They analyse problems, they find solutions, they decide, they plan, and they act. A participatory process encourages households to: ANALYSE their own problems DECIDE what should be improved PLAN how they are going to do it ACT! 60

7 Household at the Centre. Behavioural change will depend on the commitment and initiative of each household who will decide what forms of change they want to make and how they are going to do it. Each household, for example, will decide on the type of latrine they want to build or how to improve their existing latrine based on costs, ability to pay, preferences, soil types, etc. Community Support for Household Action. While households will make their own decisions (eg type of latrine) the community will support them. The process will involve group discussions where neighbours analyse problems and work out solutions. The discussions will produce common thinking and commitment to action and individuals will get encouragement and support from friends and neighbours. Empower the Community. In the old approach field workers did all the talking and the villagers listened. The new approach puts the community in the "driver's seat". The community will meet, discuss, decide, and plan what they want to do. The aim will be to get the community to own and take responsibility for these issues. Empower Women and Involve Men. Women have the most to gain from H&S&A action and are often more receptive to these changes than men; but women often need the cooperation of men to take action eg providing funds to buy materials and labour for digging and construction; or in the case of AIDS agreeing to safe sex practices. In the past men have been left out of discussions on hygiene and AIDS. There is a need to involve both men and women in planning and decision-making for these improvements. Reduce Women s Workload. Because of their heavy workload in the house and at the farm women have little time to apply hygiene practices. There is a need to promote analysis of gender roles in relation to hygiene,sanitation and home-based AIDS care and advocate for changes in work division within the household as a way of improving hygiene. Leadership by Watsan & Animators. In the past Water Committees focused primarily on water issues and had little interest in hygiene and sanitation. In the new approach their role also includes hygiene, sanitation, and AIDS. They are called Water and Sanitation Committees. They will take the lead in facilitating awareness and action on Hygiene, Sanitation, and AIDS - and the Animators (members of Watsan) will take the lead role. Your job is to help build Watsan s commitment to H&S&A and to train Animators in health promotion. Once they are committed, they will take the lead in organising community meetings on this agenda. 61

8 WASH = Water, AIDS, Sanitation, & Hygiene WHAT IS WASH? Community self-mobilisation on: Water, AIDS, Sanitation, Hygiene using: Community managed approach Problem solving, planning, action Participatory (PHAST) methods _ Small (peer) group discussion WASH gets the community to take full responsibility for developing its own health. Village leaders - Animators - lead the process. Villagers take part in discussions on health problems which have been identified by themselves. They analyse problems, find solutions, plan, take action, and monitor action. The whole process is planned and run by the community. Facilitators from outside the village train the Animators and support the process. OBJECTIVES OF WASH To improve health - Reduce water related diseases Reduce HIV/AIDS infection Improve community support for AIDS affected households To empower community members over health - to give them more control and confidence in taking action and changing habits to improve their health. PHAST means Participatory Hygiene and Sanitation Transformation. It is a participatory approach to hygiene and sanitation adopted by many countries in Africa. WASH uses this methodology and applies it to AIDS action. HOW DOES WASH WORK? Process: Peer group meetings using a participatory approach to discuss WASH problems, analyse causes and effects, identify solutions, and plan for action. This is the PHAST process, but agenda is broadened to include AIDS. Agenda: In the past the agenda was set by field workers - as a result there was little commitment to the issues. The field worker decided what things the villagers should change and delivered this to villagers in the form of messages: Don t drink surface water Drink potable water Wash your hands Clean water point In the new approach the community will set their own agenda - they will: Identify health concerns & problems Analyse their effects and causes Prioritise - and then focus on those concerns which are troubling them The broad agenda - water, sanitation, hygiene, and AIDS related issues - will be set by the programme. But the community will decide which specific issues they want to focus on. How will people meet? WASH meetings will take the form of: Peer group meetings - meetings of women or men or youth living in the same neighbourhood - which are Facilitated by Animators and other Watsan members; and Supported by outside facilitators. Peer group meetings are small enough to allow for active participation by all members. In community meetings it is hard for everyone to contribute. The peer group will not just talk; they will also work together in taking action. 62

9 WASH OBJECTIVES AND STRATEGIES OBJECTIVE A: To Build Commitment and Ownership of W-A-S-H and the Need for Change How? Watsan and Animators TAKE THE LEAD Facilitators stay in backseat supporting community initiative COMMUNITY PRIORITIES they choose the issues that they want to work on SMALL/PEER GROUPS used as pressure/support for action PARTICIPATORY PROCESS and WOMEN take a lead role OBJECTIVE B: To Build Understanding on Disease Transmission How? Check on what people know already (eg 3 Pile Sorting) Focus on knowledge gaps Use tools to show how disease is spread and can be blocked (Transmission Routes and Blocking the Routes) OBJECTIVE C: To Support Effective Behavioural Change How? Provide OPTIONS so that people have choices within their means - for example: a) Soap or ash b) Use of non-potable sources for non-drinking purposes c) Sanitation & Water Ladders d) AIDS Ladder - Abstinence, Be faithful, Condoms Introduce a Planning Process managed by the villagers Introduce MONITORING - so that people can assess their activities and results and decide what needs to be done Assess GENDER BLOCKS to change eg lack of resources (money to buy soap) by women/the poor; heavy workload as a constraint Use of PEER GROUPS - to provide mutual support MODELLING - Animators and Watsan members model the new behaviours COMMUNITY STANDARDS AND BYE-LAWS eg stopping late night dances 63

10 ANIMATORS Literacy is not a requirement to become an Animator. There will be little reading and writing required. People will be trained largely through discussion. Once selected, the Animators should be coopted onto the Watsan Committee if they are not already members. How are Animators trained? Animators will attend the basic training courses given to Watsan members. They will also be given specialist training to learn their job as Animators. Introduction The community will select their own leaders to manage the WASH meetings. These leaders, who will be members of the Watsan Committee, will be called ANIMATORS. Animators will be trained in three 2-day courses. Between each course Animators will practice their skills on the job. The courses will be run by the facilitators. Facilitators will also provide on-the-job training for Animators to help them develop skills and confidence. Animators will be given: Animator s Manual Set of PHAST/WASH tools. Who are ANIMATORS? Animators are people who facilitate peer group and community meetings on health (WASH) issues. In each village Watsan and the community will select 3-4 Animators. The team of Animators should include women, men, and youth. How are Animators selected? Animators will be selected by Watsan and the community. They will look for people who are: Active and hard-working Interested in health issues Respected by community members Willing to model the new behaviours eg constructing improved latrines, speaking openly about AIDS, etc What is the Animator s job? Animators will organise peer group and community meetings on health issues, using participatory tools. Their task is to get community members talking about health problems, identifying solutions, and planning for action. Their job is to help the community begin to see themselves as responsible for their own health. As leaders they will be expected to MODEL the new behaviours. If other villagers see them practising what they preach, they will be more likely to follow their example. 64

11 Phase 1: Mobilisation and Planning STEPS: 1 Meeting with VG and Watsan 2 Initial Community Meetings (CM) 3 Watsan Training (WT) 4 Data Collection, Problem Solving and Planning - through peer groups & community meetings 5 Watsan & community meetings to finalise FMP Step 2: Small/Peer Group Meetings Objective: Raise awareness, collect data, solve problems, and develop action plans Tools: Three Pile Sorting Transmission Routes Water and Sanitation Ladders Process: Step 1: Initial Community Meeting & Watsan Training Objective: Identify concerns and build commitment and initial awareness Tools: Community Mapping - WT WASH Walk - WT 3 Pile Sorting - WT Story with a Gap - CM or WT Outputs: Identified priority health problems eg Old sources are a health hazard HIV/AIDS Collapsing toilets Identified possible solutions - eg Build a new water supply Limit use of traditional sources Get more information on HIV/AIDS Initial priorities - example: Build new water supply Build stronger latrines Do something about AIDS Meeting A Review Key Problems (from Step 1) Check on people s knowledge level (Tool - Three Pile Sorting) If knowledge low, raise knowledge about oral-faecal transmission (Tool - Transmission Routes) Meeting B Action Planning - WATER - technology, siting, money (Tool - Water Ladder) SANITATION - Choice of technology (Tool - Sanitation Ladder) HIV/AIDS Outputs: Awareness Action plans Step 3: Preparing FMP Objective: Prepare Facilities & Management Plan Process: Community and Watsan meetings to finalise FMP 65

12 Phases 2 and 3: Implementation + O&M Hygiene Action Introduction During these phases new facilities are already in place (or will soon be completed), so health promotion will focus on the USE of these facilities. People will discuss the following topics: Use of the new water facilities Discontinuing use of old sources Keeping potable water clean Hand washing Toilet construction, use, maintenance Keeping the environment clean Taking action to prevent HIV infection Animator Training You will train Animators to facilitate these discussions with peer groups (or the whole community). Focus - Behavioural Change The idea in these sessions is to promote BEHAVIOURAL CHANGE - to get the community to agree on the new practices they are willing to adopt and then to take action. This will be achieved through problem-solving discussion, not telling the community what to do. The aim is to build real commitment to change: this will only come when villagers identify their own problems and find their own solutions. Your job will be to help them: Recognise that there are risky hygiene conditions or problems. Select which of these conditions they would like to change first. Develop a commitment to solving the problem - "Let's do it!" Come up with their own ideas on how to solve the problem. Assess solutions and decide what is realistic and do-able. TAKE ACTION! Set their own indicators and monitor the changes. This is a list of general "messages" on hygiene topics. The community will need to decide how to adapt them to their own situation. At the river or pond: Stop using water from river or pond. Use river water for non-drinking purposes. At the water point: Use potable water for drinking. Keep the site clean and well weeded. Clean drains and remove waste water. Repair cracks in apron and do backfilling. Locate clothes washing at a distance. Fetching of Water: Clean containers before filling them. Don't put leaves in the water. Storage and Use of Water: Keep containers clean and covered. Change water in storage containers on a regular basis. Use one cup for removing drinking water. Keep it clean. Show children how to get drinking water in a safe way. Washing Hands with Soap (or Ash): Wash hands before preparing food and before eating. Wash hands after defecation or handling children's faeces. Wash hands after returning from the farm. Use of Latrine: Build a latrine. Encourage all family members to use it. Teach children how to use the latrine. Put faeces of children into latrine. Sweep the slab regularly and clean often with water. Provide water and soap (or ash) for handwashing. Environment: Cover faeces. Faeces carry disease (by flies, in water, soil, food). Burn or bury refuse. Develop community refuse disposal sites. Weed around compounds on a regular basis. 66

13 How to Motivate People To Change If we are going to use water from the river, our children will get sick and we'll spend a lot of time and money at the clinic. The new pump is near our houses so our kids are no longer late for school. They used to spend hours fetching water. Our husbands no longer have to follow us. In the past they followed us early in the morning because of the long distance and security problems. The new pump will give us clean water year round. If it beaks, we can fix it immediately. If I wasn't feeling so overloaded, I wouldn't get sick all the time. Sometimes it is just too much work. Which reasons are likely to be the most convincing? Remember - people will only change if it makes a real difference in their lives. They need to see that the change will make their lives better - or they won't continue the new practice. If, for example, new hygiene behaviours require a lot more work without the women seeing any real benefits, they are less likely to adopt these new behaviours. Ask women to talk about the real obstacles which prevent them from adopting the behaviours - and then discuss with them what can be done to overcome these obstacles. How can they support each other in making these changes? One of the major factors in change on hygiene is WOMEN'S WORKLOAD. Get women and men talking about this problem and what can be done. Divide into men's and women's groups so that women have a chance to talk through what changes they would like to see before talking with the men. It will help them be more confident about telling the men what they think should be done. If the men meet on their own and decide what they can do to reduce women's burden, they are more likely to support each other to make changes. When a number of friends or neighbours change their behaviour, the change is more likely to last because people can support each other and find ways of changing. For example the men might help with the construction of a laundry area near the pumpsite to reduce the time women spend fetching water for washing clothes. USE OF OLD SOURCES Facilities have been completed, but people are still using the old sources. What can you do? _ Don't condemn or shout at people. That won't change things. It will just make people feel bad and resist change. _ Visit the old sources and the new water supply with Watsan members and ask people at each place - "Why do you like this source?" _ Help Watsan organise a meeting to discuss all of the reasons given. Start off with a drama showing the problem to make things lively. _ Analyse problem with people and ask them to find solution. _ Probe for realism - What will work? Are you willing to do it? What obstacles might prevent you from doing it? How to overcome them? 67

14 Behaviour change will happen if... People see real benefits in adopting the new practice. People recognise that certain practices are harmful and have felt the harmful effects. Children don't see bilharzia as harmful so there is no motivation to stop swimming in stagnant pools. Negative consequences of certain practices are immediately felt. New practices are decided by the community, rather than imposed from the outside - they are based on community agreement. Opinion leaders set an example eg Watsan members build latrines. Field workers are patient, respectful and supportive. They don't criticize people and don't impose their own ideas. Men and women are equally involved in problem solving, decision-making and action. People have the resources to adopt the new practices - eg money to build latrines or buy soap. People have the time to do it. If women are overloaded with work, they won't be able to do the extra work to adopt new hygiene practices (eg cleaning storage containers). Facilities are accessible - pumps which are too far away, have a long queue, or are locked at times may force people to use the old sources. New practice is seen as being "modern" or giving them status - eg the status of having a latrine. Where possible, new practices build on local beliefs, many of which are aimed at protecting community members. We know pump water is "good" and dugout water is "bad", and when we have time we go to the pump. But in the farming season there's not enough time. The pump is far and there's a long line. Yes - and the dugout is much closer. And our husbands are pressuring us to finish our housework and bring food and water to the farm. If I'm late, my husband will beat me! One obstacle to change is WOMEN S WORKLOAD. If women are to stop using surface water during the busy farming season, then their workload needs to be reduced so they can take the extra time to walk to the pump and wait in the queue. In one community where workload was discussed by men and women, they came up with the following proposals: Men assist with the household tasks Men collect their own water for bathing and washing their clothes Men carry their own food to the farm Men reduce women's workload at the farm and allow women to return home early so they can fetch pump water before it gets too late. In your own area find out why people have difficulties with the new practices. This will help facilitate problem-solving discussions focused on the difficulties. Facilities are designed to promote hygiene eg latrines designed with a place to put water and soap. 68

15 Sanitation Why include latrine building in a water programme? Safe water and safe latrines both reduce the spread of germs. By building latrines and water facilities and teaching people to use water to stop the spread of germs (eg washing hands after using latrines), you will help reduce the number of people who get sick from diarrhoea, cholera, and other diseases. Sanitation is to keep the environment clean and free from diseases. One of the most important ways to improve sanitation is to use a latrine instead of using the bush. This section will look at how you can help promote the construction and hygienic use of household latrines. A latrine is a safe place to pass stools and urine, but only when the latrine is properly constructed, well maintained, cleaned, and without flies. Otherwise the latrine will increase the risk of disease transmission instead of reducing it. Why do we need latrines? To get rid of human waste in a safe way It is easier than going to the bush Privacy & convenience for users The first reason is the most important. If we dispose of faeces in a safe way, we will reduce the spread of disease and the contamination of soil and water sources. It will help to stop the spread of diarrhoea and cholera. To have a real improvement in health everyone in family and most families in the village need to use latrines. And they need to use them in a safe way. If they don't wash their hands after using the latrine, the excreta will be passed to food or water and they will get sick. What is the new latrine program? The new latrine programme has the following features: Get households to analyse their own situation (re excreta disposal), identify optional actions to improve things, select priority actions, and plan for action Build individual commitment to improvements, using sanitation ladder - this allows individuals to choose their own options Build community agreement to sanitation improvements Develop local skills for latrine building - through training local artisans Use affordable and appropriate designs - latrines will be designed to be low-cost, safe, minimize smell and flies, and provide privacy. Promote use and maintenance of the latrines by the whole family 69

16 How will individual families participate? 1. Families will participate in community or peer group discussions on sanitation. 2. People will discuss the current condition of latrines within the community, compare optional excreta disposal methods, and decide on the level of sanitation improvement to be aimed at. 3. On the basis of these discussions individual households will prepare their own action plans, based on the resources and skills available. Roles will be assigned to family members eg dig pit, construct slab, construct superstructure, etc. 4. The family may enter into a contract with a local artisan to do some of these tasks. 5. The family may apply for a latrine subsidy from the District Council. The family will use the subsidy and its own contribution to pay for labour and materials. How to promote interest in latrines? Your role is to promote the building of household latrines, working with and through Watsan and Animators. Here are a few things you can do: Ask the following questions - What do you know already about latrines? Why do people need latrines? What are the benefits? What fears or concerns do you have about latrines? How can you build your own latrine? Build on people's knowledge and respond to their concerns. They may not like latrines because of the poor maintenance and bad smell. They may be worried about their safety. Explain that the new latrines will be stronger and no longer smelly. Explain health benefits of latrines, but don't limit yourself to health arguments. Also mention convenience, privacy, and social status. Use the SANITATION LADDER. This set of pictures shows different types of excreta disposal. Participants arrange them in a ladder from worst to best option. Then ask participants to decide which option they can afford and build. Discuss practical steps and how families can reduce costs by digging their own pit and using local materials. Get Watsan to take the lead. Remember - Watsan is a Water and Sanitation Committee. Encourage them to take responsibility for sanitation. Encourage Watsan members to be models, building their own latrines. For more information on latrine construction, see page XXXXX. 70

17 HIV/AIDS Promotion HIV/AIDS is everyone s problem. It affects HIV infected individuals, their families, and the larger community. Because of associations with immoral sex, people and families living with AIDS are stigmatised. They need support, but they are being shunned by their neighbours. An important objective of RWSSP will be to break down stigma towards people with HIV/AIDS and promote more compassion and support. Strategy for AIDS Awareness and Action: Train the Leaders. Train Watsan and Animators in the skills to facilitate community and peer group discussions. Collect Data and Develop a Plan. After being trained, the leaders will collect data on community high risk practices related to the spread of HIV, community perceptions on AIDS, and services available (eg condoms, counselling, testing). Based on this data Watsan and the community will develop a plan for HIV/AIDS education and action, which will be incorporated into the FMP. Participatory Meetings. Watsan and Animators will organise a series of community and peer group meetings (women, men, and youth) using participatory methods and tools to: Build awareness that AIDS exists and people are at risk of getting it through certain practices (eg many partners, widow inheritance, etc) Build commitment to doing something about it Personalise the risk of HIV infection and share information on modes of transmission and ways people can protect themselves Analyse barriers to AIDS prevention (eg lack of access to condoms) and factors which promote HIV transmission eg drinking, migrant labour, unemployment forcing young women into commercial sex, cultural practices (eg widow inheritance). Decide on what can be done individually and collectively to minimise the risks of infection. Analyse the needs of AIDS affected households (eg effect on production and household workload) and advocate against exclusion/isolation Decide on what can be done to support AIDS affected households eg giving exemptions from water tariffs (where they are unable to pay) Implement the plan and organise monitoring and followup support Advocate New Ideas. Watsan and Animators will promote: Recognition that AIDS exists and everyone are at risk Empowerment - a feeling that people can do something to reduce the risk of HIV/AIDS Collective action and mutual support - a commitment to work together to support each other and support AIDS affected households. Openness to talking about sex and HIV/AIDS Stamp Out Stigma (SOS) - break the stigmatisation practised against AIDS affected households. Schools Programme. AIDS awareness will be included in schools programme so that young people have the knowledge and confidence to practice safe sex. 71

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