REACH Co-op Lab: Working for Inclusive WaSH in Malawi

This practice of open defecation undermines human dignity and increase the risk of diarrheal diseases and parasitic infection in the surrounding areas. In 2008, the Water Supply and Sanitation Collaborative Council(WSSCC) established the Global Sanitation Fund (GSF) with country-specific programs to improve access to sanitation facilities and to adopt good hygiene practice in the community setting in the target country.

GSF programs in many low-income countries used the community-led total sanitation (CLTS) approach to motivate target communities to build latrines (toilets) for their own use. Evaluation of sanitation and hygiene program in low-income countries generally assesses whether there are latrines in the target communities, i.e., access to sanitation facilities. However, other essential questions remain unanswered, such as:

1. Do people living in the target communities (the "target population") actually use the latrines that they built? 
2. Is there any room for improvement in the way that the program motivates the target population to use the latrine? For example, was participation in the program associated with higher level of social norms for latrine use, which can subsequently drive latrine use behavior?
3. Are people with limited mobility and vision in the target population also able to use the latrines?
4. Are the latrines safe and private for women in the target communities?

All of these questions are essential for a more complete understanding of the successes and existing challenges of the program, and will help guide the design of a more effective and inclusive sanitation promotion program in the future.

The REACH Co-op Lab and the Community for Global Health Equity at the University at Buffalo were approached by WSSCC to provide technical support for the GSF program evaluation in the Republic of Malawi, in collaboration with faculty members and alumni of the Department of Environmental Health, the Malawi Polytechnic in Blantyre, Malawi. The tasks of the UB team include designing the evaluation data collection tools (based on the above-mentioned unanswered questions), sampling the target communities, training the local data collectors, and observation and feedback regarding the field data collection process. Training, pilot-testing and actual fieldwork took place from March 2017 to May 2017. Data collected in the survey helped to provide insights on use of latrine facilities, ability for people with limited mobility or vision to use the latrine, and safety and privacy concerns reported by women in the target population. The survey data will help to inform future water, sanitation and hygiene program design, implementation and evaluation efforts, and will also be analyzed by the team at UB and collaborators to generate empirical evidence to inform best practices.