1. www.icddrb.org Development of a shared latrine cleanliness and maintenance intervention for low-income urban communities in Dhaka, Bangladesh Farzana Yeasmin Research Investigator WASH Research Group icddr,b 26 October Water and Health Conference Chapel Hill, North Carolina 2015

2. Roles of research partners  This study is part of a research programme initiated by WSUP and funded by DFID  icddr,b o Develop and evaluate the behavior change intervention package to improve shared sanitation in Dhaka o Identify and disseminate lessons relevant for other low income urban settings  WSUP o Identified the research question, and engaged different stakeholders in urban sanitation o Financially supported the project o Provided technical feedback on the intervention package 2

3. Background Nearly 15 million of Bangladesh’s inhabitants live in Dhaka of whom - approximately six million reside in urban slums and - 4.3 million use communal latrines Communal latrines are considered financially and technically viable option in Dhaka’s 5,000 slums 3

4. Background Improper maintenance of communal latrines, including safe and timely removal and disposal of fecal sludge, spreads diarrheal pathogens in the surrounding communities Proper maintenance of communal latrines is complicated: - Lack of social cohesion - Technical problem - Poor governance 4

5. Objective To develop and pilot a behavior change intervention that addresses the obstacles affecting communal latrine maintenance in urban Dhaka 5

6. Study sites and duration Nov 2013 to Dec 2014 Two low-income communities o International NGO piloting toilet improvement interventions o NGO-trained fecal sludge remover identified problematic toilet blockages 6

7. Study design Phase-1: Identifying the Barriers to Fecal Sludge Management Phase-1: Identifying the Barriers to Fecal Sludge Management Phase-2: Selecting and Pre-Testing the Intervention Phase-2: Selecting and Pre-Testing the Intervention Phase-3: Pilot test and assess the acceptability and feasibility of the intervention package Phase-3: Pilot test and assess the acceptability and feasibility of the intervention package

8. Phase 1: Identifying the Barriers to Fecal Sludge Management Objectives: o To identify obstacles to communal latrine cleanliness and functionality o To explore waste disposal practices as they relate to communal latrine use Participants: o Fecal sludge removal operators (5) o Adult toilet users (5) proximal to blocked toilets who are caregivers of children under 2 Methods: In-depth interviews 8

9. Phase 1 Findings Two important barriers for communal latrine cleanliness: - Inappropriate trash disposal - Limited/inconsistent water availability

10. Phase 2: Selecting and Pre-Testing the Intervention Objectives: o To develop and elicit community feedback on behavior change communications o To select waste bin and water storage hardware for pilot testing Participants: residents, landlords, and children Methods: focus group discussions

11. 70L plastic reservoir and 4L flushing bucket Two types of 12L plastic waste bin Selected intervention for solid waste disposal and water availability 11

12. Materials to promote behavior change: Proper waste disposal Do not dispose waste in the latrineDispose waste into the waste bucket 12

13. Materials to promote behavior change: Cleaning and flushing We will take a bucket of water from reservoir bucket for flushing We will clean latrine after defecation by pouring water into the latrine 13

14. Phase 3: Pilot test Objective: To assess the acceptability and feasibility of the intervention package Participants: Residents of two urban slums 14

15. Phase 3: Pilot test intervention-waste disposal A.12-liter bin for waste disposal B.Signs indicating appropriate waste disposal behaviors 15

16. Phase 3: Pilot test intervention-flushing A.Signs indicating appropriate flushing behaviors B.Small, 4-liter bucket for flushing C.Large water storage reservoir with scoop inside 16

17. Phase 3: Intervention pilot assessment Spot checks of waste bins & water storage hardware: daily for 2 weeks Method/ToolsParticipantsN Indepth Interview Toilet users32 Bin cleaners,6 Landlords6 Care givers of children who use potty4 Focus group discussion Adult female toilet users10 Key informant interview Implementers of project promoting child potty use 2

18. Phase 3 Findings-benefits Residents refilled the water reservoir Designated cleaners to empty waste bins Reduced toilet blockage and odor “We would hold a cloth over our nose to use the latrine. Sometimes we fainted in the latrine. After the construction of the latrine it was in this bad condition. Now you have given us materials and the latrine remains much better than before.” (Male resident, water scarcity area) Using a potty was easy and more convenient than cleaning up feces from the floor 18

19. Phase 3: Findings-barriers Disgust and menstrual management “Although this bin has a lid, whenever we open it, I feel disgust. This should be a confidential matter as it is an embarrassing matter.” (Male resident, 31 years old) Delayed bin emptying by volunteers Male residents urinate on the latrine floor and walls creating a bad odor Children made a mess while defecating 19

20. Addressing barriers Additional signs for parents and male residents Latrines remained clean because of these additional messages

21. Final intervention hardware o Waste bin design selected on the basis of most convenient to maintain o Water storage set with flushing bucket and scoop 21

22. Final Intervention messages

23. Final intervention activities Behavior change communication messages delivered by community health promoters Interpersonal communication sessions with waste bin emptiers, landlords and residents Group meetings with fecal sludge emptiers A cue card describing the benefits of purchasing and using a potty to encourage caregivers

24. Conclusion Community input and iterative intervention piloting identified: o Key audiences o Enabling low-cost hardware and communication messages o Methods to improve shared toilet functionality and cleanliness 24

25. www.icddrb.org Study team Icddr,b: Leanne Unicomb Farzana Begum Fosiul Nizame Mahbub-Ul Alam Notan Chandra Dalia Yeasmin Khubair Hossain Abdullah-Al Masud 25 For more information: fyeasmin@icddrb.org Stanford University: Stephen Luby WSUP: Guy Norman Anita Layden Abdus Shaheen Habibur Rahman Nasrin Akter Johns Hopkins University: Peter Winch Ronald Saxton Acknowledgement: Study participants; Diana DiazGranados; Astrid Dier, Dr. Mahbubur Rahman

26. www.icddrb.org Our Donor 26