An enormous amount of money has been spent on sanitation facilities around the world, yet 2.5 billion people still lack access to basic services. Often, toilets and washing facilities are built and relatively high ‘coverage’ is reported, but toilet use remains low and little or no benefit is derived. Awareness is growing among public health practitioners that sanitation hardware alone is not sufficient and until hygiene is properly practised at home and in the community the desired benefits of improved water and sanitation services on community health cannot be realised.

Since the 1970s, practitioners have looked for ways to reduce the huge number of people who remain without access to a toilet and to increase the number of those who use facilities when they are available. Now WSSCC has published a guide to describe the various hygiene and sanitation 'software' approaches that have been deployed over the last 40 years by NGOs, development agencies, national and local governments in all types of settings - urban, informal-urban and rural. The guide, "Introduction to Hygiene and Sanitation Software: a Selection of Approaches," describes these approaches and explains why the human ‘software’ element is so important.

Speaking the same language

The terms 'hygiene' and 'sanitation' can be used in different ways. In this report 'sanitation' is used to refer to the management of human excreta while 'hygiene' refers to behaviours and measures required to manage human faeces and to go beyond this to break the chain of infection transmission in the home and community.

Although all aspects of home hygiene are important, there is a general consensus that hygiene promotion programmes are more likely to be successful in changing behaviour if they focus on a small number of activities at one time. This means understanding how infectious diseases are transmitted and prioritising practices to combat the greatest risks such as diarrhoeal disease, respiratory tract infections and skin and eye infections. Once these beneficial practices are in place, other interventions can be introduced. The 'ranking' of risks may vary from one community to another – in some communities poor food hygiene may carry greater risks than those associated with poor household water quality.

The document defines hygiene and sanitation 'hardware' as toilets, pipes, sewers, taps, soap and ancillaries such as pit-emptying equipment. 'Software' encompasses all those activities that focus on hygiene and/or sanitation promotional activities -- in short everything related to creating the 'enabling environment', the political, legal, institutional, financial and economic, educational, technical and social conditions within which a hygiene or sanitation programme operates. Most importantly, 'software' is about human behaviour and interaction, and therefore highly culturally and socially sensitive.

The WHO/UNICEF Joint Monitoring Programme in 2008 estimated that more than 700 million people in India still have little choice but to defecate in the open while in Africa the number of people without sanitation has actually grown in the past decade. A 2008 assessment by WaterAid suggests that poor sanitation may be linked to as much as a quarter of all under-five deaths. Meanwhile, other research shows that hygiene promotion can create demand for sanitation; thus hygiene promotion not only has the potential to increase the health impact of WASH programmes, but also to increase sanitation coverage. Indeed, hygiene and sanitation promotion is now considered the most cost-effective way of reducing diarrhoeal disease among children in particular. Effective hygiene and sanitation software is therefore seen as a critical component in the campaign to improve public health and to reduce related morbidity and mortality.

Clarifying different software approaches

A main purpose of the guide is to clarify some of the confusion about terminology and language and to provide a ready reference or introduction to some more commonly-used approaches. “Introduction to Hygiene and Sanitation Software” is a resource tool both for the newcomer to the subject and for the more experienced practitioner who wishes to learn about other approaches. The guide is not an evaluation and does not attempt to compare or rank software approaches, but it provides a snapshot of current software and a basic analysis of these approaches and their applicability in certain situations.

By Tatiana Fedotova, Communications Officer, WSSCC

The report will soon be available on http://www.wsscc.org.

For more information contact Carolien van der Voorden, Programme Officer Networking and Knowledge Management, at carolien.vandervoorden@wsscc.org.

Tags: hygiene promotion, information and communication, on-site sanitation, participatory management, sanitation, school sanitation, water-related diseases