Aquaya has recently begun a new research initiative to study the supply and demand of improved latrine slabs in rural Tanzania. With our Tanzanian research partners, MSABI, we’ve started to conduct scoping visits to possible study regions. The study will assess the supply business models for both plastic latrine slabs and concrete Sungura SanPlats. As a part of the recent National Sanitation Campaign led by the Ministry of Health and Social Welfare, and through previous endeavors, Sungura SanPlats have been introduced and masons have been trained in their construction. While some areas have responded positively to the campaign and have improved their existing latrines or built new latrines, uptake hasn’t been consistent across the country. Many regions are still lacking proper improved sanitation, according to the Joint Monitoring Programme (JMP) definition.
Aquaya has been contracted by the World Bank’s Water and Sanitation Program to study the supply and demand of these platforms in order to better understand how the country of Tanzania can increase their percentage of improved latrines. Our scoping visits have been spent meeting with many of the parties involved with improving sanitation. We met with the Ministry of Health at both the national and regional levels, and discussed the progress of the National Sanitation Campaign. We met with village leaders and enumerators for the local areas to see what the perceived level of sanitation is at a rural scale. We met with many masons and local concrete entrepreneurs to learn about their skills and the application of those skills towards improving sanitation. And we met with local villagers to learn about their lifestyle and the role that sanitation plays in their lives. All of these visits will help shape our proposed research design.
As we move forward, we are organizing a willingness-to-pay study with a voucher system to see what the demand is like for rural villagers. Households in selected towns will be interviewed about their current sanitation practices, and if their current level of sanitary services is unimproved, they will receive a voucher for either a plastic latrine slab or a concrete latrine slab at a reduced price. Based on the sales of these slabs at different prices, we will be able to determine a demand curve for each product and determine at what price point there is substantial demand for the product. The plastic latrine slab is a new product, recently unveiled in Kenya, and we are interested in seeing if there is high demand for the product. The local manufacturers are excited at the prospect of studying the demand of the product and have been collaborating with us.
Nuances of the study will also explore other factors that may influence latrine demand. We will be testing demand as it compares to villages who have been exposed to the National Sanitation Campaign and those who have not. We will be looking at the effects of seeding the slabs prior to the demand study, to see if word-of-mouth influences demand. In addition, we will be swabbing latrines and testing for the presence of fecal coliform. Households will be informed of the results during the period of time in which they can purchase the latrine slabs, to see if education about their risk of disease increases demand of sanitation improvements. The data will also help inform us on the impacts of using latrine improvements as a way to reduce potential disease burden.
We have completed preliminary visits to the regions we’ve selected and will soon complete a more intensive visit to finish determining the logistics for the study. We hope to have the two teams of enumerators out in the field doing initial interviews in February and March before the rainy season arrives. Stay tuned!
by Annette Fay and Emily Kumpel
Originally written as a guest post for Dimagi blog.
When health agents take water samples from rural water points in Sénégal, what additional information should they record? Rien à signaler – nothing to report/no observation – is not the answer. Especially if that water point isn’t recorded anywhere, or only one person on your team knows how to drive there – and an entire community depends on that water to survive. This was emphasized by the national Water Quality Manager at Service National de l’Hygiene (SNH) to health agents in our training on a new CommCare app that enables collection and submission of water sampling data through mobile phones in real time. SNH is one of our 26 partners across 6 countries in sub-Saharan Africa that are part of the 3-year research project, Monitoring for Safe Water (MfSW), that seeks to understand the challenges health surveillance agencies and water utilities face in testing water quality. Testing for water is a critical component in providing safe drinking water and happens behind the scenes on a regular basis in developed countries. We at the Aquaya Institute, a non-profit research and consulting organization that improves access to safe water and sanitation in developing countries, are identifying the challenges faced by institutions in testing drinking water and working to find strategies to solve them.
One of the challenges that we have seen in the water quality testing programs among many of our 26 partners in sub-Saharan Africa is that of data management; even if they can test, to get the results to a regional or national office can require transportation and substantial amounts of staff time. Our partner in Sénégal, the National Hygiene Service (Service National de l’Hygiène, or SNH) has had a very successful water quality monitoring program since last August 2013 and have conducted over 2575 water tests for 5 parameters in 13 different sub-brigades (the smallest health center unit) – a large amount of water quality data to be sent from remote rural regions, standardized, and interpreted. Many of the sub-brigades struggle to borrow a computer from a different government office to email the data to the national office or send loose paper data sheets with colleagues who happened to be traveling to the regional office.
To address this and other challenges, we’re using CommCare as a self-starter with SNH to see if an ICT tool can improve management of water quality data collected from rural areas in Sénégal. We observed that the 13 sub-brigades recorded different information about water points when they collect samples (for example, different information about the sanitary condition surrounding a water source – or nothing at all). Our goal was to make an app that fit with their existing data collection practices while also using the opportunity to standardize data collection so that it was useful to the sub-brigades, regional and national offices. We chose CommCare for a mobile platform because of our team members’ previous experience with Open Data Kit (ODK), user-friendliness of designing and building an app, and the options for support that CommCare offers. SNH is excited about this project because it will be the first time mapping all of the water points and will streamline their data management. Up until now, sub-brigades in rural Sénégal sent water quality data once a month to a regional manager who then sends it on to the national level. All follow-up to the sub-brigades was done by phone and there is little interaction between the national and sub-brigade levels.
How did we work with SNH to set up our CommCare application? After spending time in the field making sure we understood existing practices, we went through CommCare’s tutorials to learn the system and developed our questionnaire using CommCare’s template. We then used the questionnaire to create a preliminary version of the application in French and review the content of the forms with SNH’s national staff. We trained four sub-brigades in just one region of Sénégal to use CommCare to submit their water quality testing data. In our program, we are using CommCare’s case management feature – each water sample is a case, tracked through 4 forms: 1) record basic information about the water point when collecting samples (including GPS coordinates and information about the sanitary conditions of the water source); 2) record physico-chemical parameters of the sample when testing is conducted in the health office; 3) record microbial testing results the day after sampling; and 4) record actions agents take in response to the water quality of the sample. We made many changes to the content of our forms based on feedback from the health agents during the training and first few days trying it out in the field. We found CommCare easy to use to develop an application and Dimagi staff responsive over the mailing lists when we ran into problems we couldn’t solve on our own.
The training itself consisted of two days of classroom instruction covering how an Android phone works, the content of the forms and how to use the app. We emphasized breakout sessions so the 35+ participants could practice in small groups what we reviewed as a large group. We created test logins for people with their own Smartphones to use our CommCare app on their own. Following the classroom training, we visited each sub-brigade for half a day and accompanied the sampling teams while they used the app for the first time to record sampling data from two samples.
Currently we are piloting the app in one region in Sénégal and we plan to roll out the program to two other regions in the coming weeks. We’re continuing to develop this application based on feedback from the SNH agents using it and are encouraged by their desire to develop their own CommCare application for other aspects of their work. We intend to transfer management of the project to our implementing partner in December 2014 and at this time they will be able to decide how much support they need and can afford.