Cleanliness is nearest to…

Promoting hygiene best practices in Malawi

Lilongwe – Open defecation and poor hand-washing practices continue to accelerate the spread of diseases in the Southern African nation of Malawi.
To fight the vices, a Malawi NGO called Circle for Integrated Community Development (CICOD) has been implementing a sanitation and hygiene programme in the mountainous central region district of Ntchisi.
Their aim is to promote adoption and use of improved and sustainable latrine technologies by encouraging households to cease the districts’ common practice of defecating on open ground.
The NGO is also pushing for adoption of ecological sanitation, where communities can get economic benefits through safe re-use and recycling of human waste.
Current available data indicates that diarrhoea remains one of the major diseases in the district, causing illness and deaths of young children because of high prevalence of open defecation.
According CICOD executive director, Amos Tizora, household access to pit latrines in Ntchisi district averages around 89 percent.
“This is slightly above the national average of 80 percent,” he says, but is quick to point out that the majority of the pit latrines – about 77 percent of them – are traditional unimproved holes in the earth.
“The rate of improved pit latrines is only 14 per cent which is very far below the national coverage of 55 per cent,” he says.
Tizora adds that limited coverage of pit latrines makes people adopt other unsanitary means of disposing excreta, such as using the bush, which contributes to an increase in the spread of water-borne diseases.
The official observes that although a considerable number of people have pit latrines, only 49 percent of the households wash hands after visiting the toilet.
“This means that more than half of the communities do not wash hands after using a latrine, which is a health concern.”
The Ntchisi District economic profile indicates that coverage of other sanitary facilities is also low, with use of rubbish pits hovering at 39 percent, while use of kitchens stands at 82 percent and availability of bath shelters is at 75 percent.
Tizora says Ntchisi District is one of the areas of Malawi with low investment sanitation and hygiene.
He also notes that the district registers one of the country’s lowest literacy rates; a situation which he believes contributes to peoples´ failure to hold duty bearers accountable and demand their rights to access safe sanitation services and adequate hygiene practices.
The official says the district also has high levels of sharing sanitation facilities such as latrines and bathrooms. This sees about six people out of every 100 opting for open defecation without hand-washing.
The NGO boss says it is this situation that prompted CICOD to step into the district with interventions tailored to improve the health of the people through increased and sustainable access to safe sanitation services and facilities and increased adoption of safe hygiene practices.
The project targets about 32 000 people in 5 000 households covering 140 villages and four market communities in the district.
“We are empowering communities in effective advocacy so that they take responsibility for their rights to safe sanitation services,” says Tizora, adding that his organisation is also promoting individual household sanitation to increase improved sanitation coverage and best usage of sanitation and hygiene facilities.
“This is expected to translate into reduction in diarrhoea cases, increased community responsibility and increased district budgetary allocation to sanitation and hygiene sector,” he says hopefully.
CICOD employs what it calls a Community-Led Total Sanitation (CLTS) approach. With this method, the community is encouraged to promote safe sanitation and adequate hygiene practices, while the NGO lobbies the decentralised local government through the District Executive Committee to advocate for increased resource allocation to sanitation and hygiene sector for the benefit of the un-served households and communities.
“We are using social change strategies to transform bad habits and attitudes into best practices regarding the manner in which people at household and community levels manage personal hygiene with main focus on hand-washing at critical times and sanitation with main focus on latrine usage,” says Tizora.
He then points out that he believes the people-centred approach shall empower the communities to act on the social system and environment that surrounds them, thereby ensuring project sustainability in the long run.
Through the CLTS approach, communities have been enabled to develop and implement collective actions to stop open defecation.
The project recognises special groups – including children, women and the girl child – who require special attention in different aspects of life including where sanitation and hygiene are concerned through ensuring rights-based programming.
This is significant in that disadvantaged groups are fairly treated and they equitably participate in development activities and decisions that affect their livelihoods.
The project is also working with relevant health extension workers and young peer educators in schools that are within the communities to ensure project sustainability.
However, Tizora bemoans that most people in the district have low literacy levels and this leads them not to attach priority to issues of sanitation and hygiene unless there is a perceived threat.
“This in turn has led to poor community participation,” he says, but adds that to counter the trend, CICOD is using participatory approaches, and consultative and sensitisation meetings with the community leadership and various stakeholders in order to enhance their understanding and appreciation of the benefits of sanitation and hygiene best practices.
Tizora says CICOD intends to extend the project lifespan to allow for continuity and consolidation of the changed behaviours and practices as some community members are slow in adopting new technologies and internalise new behaviours.
“There should be more time to effect the changes or new strategies built on lessons learnt in the course implementation of the initial project such as the need to adequately complement CLTS with sanitation marketing as well as introducing a self-help group concept which shall empower the households economically and be able to afford improved sanitary products as they move through the sanitation ladder after being triggered,” he says.

March 2013
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