Household survey

125 Pages·2015·2.32 MB·English

by  Walter Kofler

Swiss TPH | Hygiene and Sanitation Survey, Senegal – Final report – Final version_15.12.2015
Swiss Center for International Health

Water and Sanitation Program, World Bank
Household survey: hygiene and sanitation
behavior as well as willingness to pay in rural
Senegal

Support to the Direction de l'Assainissement
Final report

Swiss TPH ISED Consultants
Lise Beck Mayassine Diongue Sylvain Faye
Peter Steinmann Cheikh Fall Tidiane Ndoye
Ibrahima Sy Adama Faye Alioune Touré
Martin Bratschi Anta Tal Dia
Kaspar Wyss

Basel, 15 December 2015
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Swiss TPH | Hygiene and Sanitation Survey, Senegal – Final report – Final version_15.12.2015
Contacts

Swiss Tropical and Public Health Institute Institut de Santé et Développement (ISED)
Socinstrasse 57 Université Cheikh Anta Diop de Dakar (UCAD)
P.O. Box BP 16390
4002 Basel Dakar-Fann
Switzerland Senegal

Kaspar Wyss Anta Tal Dia
Head of Systems Support Unit Director ISED
Swiss Center for International Health (SCIH) Tel: [phone]
T: [phone] Fax: [phone]
F: [phone] E-mail: [email protected]
E-mail: [email protected]

Website: www.scih.ch / www.swisstph.ch Website: http://www.ised.sn/

Funding
This study was undertaken on behalf of the Water and Sanitation Program (WSP), a multi-
donor partnership administered by the World Bank Group, which aims to support poor
populations in obtaining affordable, safe and sustainable access to water and sanitation
services.

Disclaimer
The views and ideas expressed herein are those of the authors and do not necessarily imply
or reflect the opinion of the Institute, WSP or any other institution involved in the study.
The reference version of the present report is the French version. In case of any
discrepancies arising between the two versions, the French version of the report prevails.
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Swiss TPH | Hygiene and Sanitation Survey, Senegal – Final report – Final version_15.12.2015
Acknowledgements
This study was conducted in the framework of the collaboration between the Water and
Sanitation Program (WSP), the Swiss Center for International Health of the Swiss Tropical
and Public Health Institute (Swiss TPH) and the Institut de Santé Publique et de
Développement (ISED) in Dakar, Senegal. Numerous people were involved and actively
contributed to this piece of work. We are grateful to Jacqueline Devine and her team from the
WSP in Washington as well as to M. Oumar Diallo and M. Adama Mbaye from the WSP
office in Dakar for their support in the current study as well as for their valuable comments.
A thank you to all investigators for their hard work during the data collection in often
challenging conditions in remote areas.
Thanks to Finou Thérèse Mendy, Waly Diouf, Mame Soukèye Mbaye, Mouhamed Badji for
their active participation in the focus groups and the one-on-one interview. Also a big thank
you to all investigator and cartographer from the National Service of Hygiene who
participated in the household survey.
Last but not least, the current study would not have been possible without the contribution of
all the heads of household, key informants, and participants of the focus group discussions.
We always felt welcome.

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Abreviations
ANSD Agence Nationale de la Statistique et de la Démographie
CD Census District
CI Confidence interval
CLTS/ATPC Community-Led Total Sanitation / Assainissement Total Piloté par la Communauté
DHS/EDS Demographic and Health Survey / Enquête Démographique et de Santé
EAA Eau et Assainissement pour l’Afrique
EKNZ Ethikkommission Northwest- und Zentralschweiz
GSF Global Sanitation Fund
GTS Groupe Technique de Suivi
ISED Institut de Santé et Développement
JICA Japan International Cooperation Agency
JMP Joint Monitoring Program
MDG/OMD Millennium Development Goal / Objectifs du Millénaire pour le Développement
NGO/ONG Non-Governmental Organization / Organisation Non Gouvernementale
OD Open defecation
ODF Open defecation free
OR Odds ratio
PEPAM Programme d'Eau Potable et d'Assainissement du Millénaire
RC Rural community
RGPH Recensement Général de la Population et de l’Habitat
SCIH Swiss Center for International Health
SRA Service Régional de l’Assainissement
Swiss TPH Swiss Tropical and Public Health Institute / Institut Tropical Suisse et de Santé Publique
ToR Terms of Reference
UCAD Université Cheikh Anta Diop
UNICEF United Nations Children’s Fund
VIP Ventilated Improved Pit
WHEPSA Women’s Health Education and Prevention Strategies Alliance
WSP Water and Sanitation Program

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Table of contents
Résumé ............................................................................................................................... 10
Summary ............................................................................................................................. 17
1 ...... Introduction and Objectives ..................................................................................... 23
1.1 Background ........................................................................................................ 23
1.2 Objectives .......................................................................................................... 25
2 ...... Literature review ....................................................................................................... 26
2.1 Methods ............................................................................................................. 26
2.2 Availability and use of latrines, management of child feces and hand
washing .............................................................................................................. 26
2.3 Opportunities ...................................................................................................... 29
2.4 Factors influencing capacity ............................................................................... 30
2.5 Motivations ......................................................................................................... 33
3 ...... Methods ..................................................................................................................... 35
3.1 Study location .................................................................................................... 35
3.2 Definition of improved latrines ............................................................................ 35
3.3 Household survey .............................................................................................. 36
3.3.1 Study population and inclusion criteria .................................................. 36
3.3.2 Sampling frame .................................................................................... 36
3.3.3 Sample size and representativity .......................................................... 37
3.3.4 Household questionnaire ...................................................................... 38
3.4 Focus group discussions and key informant interviews ...................................... 38
3.4.1 Participants ........................................................................................... 38
3.4.2 Sampling .............................................................................................. 39
3.4.3 Topics and organizations targeted by focus group discussions and
key informant interviews ....................................................................... 40
3.5 Data collection teams, training and pre-test ........................................................ 41
3.6 Data collection, entry and analysis ..................................................................... 42
3.6.1 Management of data collection in the field ............................................ 42
3.6.2 Data entry and storage ......................................................................... 42
3.6.3 Data analysis ........................................................................................ 42
3.7 Quality assurance and control procedures ......................................................... 43
3.8 Ethical considerations ........................................................................................ 44
3.9 Study limitations and bias ................................................................................... 45
3.9.1 Sampling .............................................................................................. 45
3.9.2 Possible bias ........................................................................................ 45
4 ...... Results ....................................................................................................................... 46
4.1 Participation ....................................................................................................... 46
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4.2 Characteristics of households and respondents ................................................. 46
4.3 Ownership and use of latrines, hand washing, defecation practice and
management of child feces ................................................................................ 49
4.3.1 Availability of sanitation infrastructure ................................................... 49
4.3.2 Latrine use............................................................................................ 55
4.3.3 Open defecation practice ...................................................................... 58
4.3.4 Management of child feces ................................................................... 60
4.3.5 Water supply ........................................................................................ 62
4.3.6 Hand washing ....................................................................................... 63
4.4 Characteristics of latrines in households with latrines ......................................... 67
4.4.1 Technical characteristics of latrines and superstructures ...................... 67
4.4.2 Participation in latrine construction ....................................................... 68
4.4.3 Maintenance and cleaning of latrines .................................................... 71
4.4.4 Financing of latrines ............................................................................. 72
4.5 Opportunities, abilities and motivations to acquire latrines ................................. 76
4.5.1 Perceived availability of professionals and building materials ............... 76
4.5.2 Satisfaction with the current place for defecation .................................. 77
4.5.3 Ideal latrines ......................................................................................... 82
4.5.4 Decision taking ..................................................................................... 83
4.5.5 Willingness and capacity to pay ............................................................ 85
4.5.6 Barriers to build/renovate latrines ......................................................... 90
4.5.7 Motivations to acquire latrines .............................................................. 93
4.5.8 Improvements and acquisition plans ..................................................... 95
4.5.9 Social norms, values and beliefs .......................................................... 96
4.6 Information channels ........................................................................................ 100
4.6.1 Frequency of media consumption and information channels............... 100
4.6.2 Preferred information channels and community participation .............. 102
5 ...... Discussion and course of action ........................................................................... 105
5.1 The relevance of the socio-economic status for access to sanitation ................ 105
5.2 The relevance of taking into account the geographic location........................... 105
5.3 Necessary efforts to reduce OD and increase latrine use ................................. 106
5.4 The need to install hand washing stations ........................................................ 107
5.5 Maintenance and cleaning of latrines ............................................................... 107
5.6 Capacity and willingness to pay ....................................................................... 108
5.7 Increase the involvement of the population ...................................................... 108
5.8 Norms, values and beliefs ................................................................................ 109
6 ...... Conclusions ............................................................................................................. 110
7 ...... References ............................................................................................................... 111
Appendix A: Study protocol ............................................................................................ 114
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Appendix B: List of selected CDs ................................................................................... 115
Appendix C: Household questionnaire ........................................................................... 117
Appendix D: Key informant interview guides ................................................................. 118
Appendix E: Focus group interview guides ................................................................... 119
Appendix F: Results of multivariate logistic regression models .................................. 120

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Table of figures
Figure 1. Map of Senegal. .................................................................................................... 23
Figure 2. Estimated improved latrine coverage and rate of open defecation (% of the
rural population), 1990-2015, Senegal (JMP). ......................................................... 24
Figure 3. Map of the 14 regions of Senegal. ......................................................................... 35
Figure 4. Percentage of households that have improved latrines and those who do not
have latrines by region. ........................................................................................... 51
Figure 5. Percentage of less poor households and households with improved latrines
by region. ................................................................................................................ 52
Figure 6. Frequency of use of latrines available in the household as declared by the
respondent.............................................................................................................. 55
Figure 7. Open defecation frequency of respondents owning latrines. .................................. 59
Figure 8. Main sources of drinking water according to the socio-economic score of the
household. .............................................................................................................. 62
Figure 9. Frequency of handwashing with soap after satisfying one's needs and before
a meal. .................................................................................................................... 64
Figure 10. Types of latrines constructed by latrine construction programs. ........................... 70
Table of tables
Table 1. Distribution of CDs and number of households selected. ........................................ 37
Table 2. Type of data collected in the course of the household survey. ................................ 38
Table 3. Rural municipalities selected as part of the qualitative approach. ........................... 39
Table 4. Summary of the information collected during the qualitative approach. ................... 40
Table 5. Number of households interviewed by CD. ............................................................. 46
Table 6. Socio-demographic characteristics of respondents, stratified by region. ................. 46
Table 7. Socio-demographic characteristics of the respondents, stratified by whether or
not they have latrines, enough water and their socio-economic status. ................... 48
Table 8. Availability of sanitation infrastructure in households, stratified by region and
socio-economic status. ........................................................................................... 50
Table 9. Latrine use among the holders of latrines, stratified by zone and type of latrine
owned. .................................................................................................................... 55
Table 10. Water supply, stratified by geographic area and type of latrine owned. ................. 63
Table 11. Percentage of households where a place for handwashing was observed,
and among these households, availability of water and soap (in %).1 ..................... 65
Table 12. Percentage of households with latrines having specific characteristics,
stratified by region, type of latrine and socio-economic score. ................................ 68
Table 13. Percentage of households where specific persons participated in the
construction of the latrine, stratified by geographic area, type of latrine and
socio-economic score. ............................................................................................ 69
Table 14. Latrine use and key contribotors to the construction of the latrine. ........................ 70
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Table 15. Main indicators of cleaning and emptying latrines, stratified by socio-
economic score and the type of latrine; frequencies reported by respondents
(%) .......................................................................................................................... 71
Table 16. Average household expenditures for latrines, stratified by region, type of
latrine owned and socio-economic score. ............................................................... 73
Table 17. Sources of funding and in-kind support for the acquisition of latrines, stratified
by region, type of latrine owned and socio-economic score. ................................... 74
Table 18. Perceived availability of professionals and materials, stratified by region. ............. 77
Table 19. Satisfaction with place of defecation and features of favorite / least preferred
latrines, stratified by type of latrine owned and geographic area. ............................ 78
Table 20. Attributes expected of the superstructure of the favorite latrines, stratified by
type of latrine owned and region. ............................................................................ 82
Table 21. Decision to renovate or build latrines, stratified by type of latrine used and
region (percentage of respondents). ....................................................................... 84
Table 22. Opinion on the opportunity to one day acquire the latrine of choice, stratified
by latrine of choice and socio-economic score (percentage of respondents). .......... 85
Table 23. Ability to pay, stratified by the socio-economic score and the region. .................... 86
Tableau 24. Main obstacles to the installation / rehabilitation of latrines, stratified by
region and type of latrine owned. ............................................................................ 90
Table 25. Main obstacles to the installation / rehabilitation of latrines, stratified by socio-
economic score. ..................................................................................................... 91
Table 26. Major expenses reported by respondents when money is available by socio-
economic score. ..................................................................................................... 91
Table 27. Motivation for the construction and benefits of having a latrine, stratified by
region, type of latrine owned and socio-economic score. ........................................ 93
Table 28. Main events prompting the construction or renovation of latrines, stratified by
type of latrine in the household. .............................................................................. 94
Tableau 29. Percentage of respondents who agreed with certain standards, values and
beliefs, stratified by the type of latrine owned and frequency of latrine use
(among the holders of latrines). .............................................................................. 97
Table 30. Media consumption frequency and main sources of information, stratified by
region, type of latrine owned and socio-economic score. ...................................... 101
Table 31. Preferences in terms of information channel and community participation,
stratified by geographic area, type of latrine owned and socio-economic score. ... 103

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Résumé
Contexte
Les indicateurs en lien avec l'approvisionnement en eau de boisson indiquent que 32% de la
population rurale sénégalaise s'approvisionnent à l'eau courante à domicile et 35%
s'approvisionnent à une autre source d'eau améliorée. Par contre, 33% de la population
rurale s'approvisionnent toujours à une source en eau non améliorée, dont 1% à l'eau de
surface (WHO/UNICEF, JMP, 2015). L'accès à l'eau est également fondamental en termes
d’hygiène, notamment pour le lavage des mains. Or, en milieu rural, un endroit spécifique
pour se laver les mains a été observé dans moins de 24,8% des ménages. Parmi ces
derniers, seuls 44.6% se lavaient les mains avec de l'eau et du savon; 18.7% avec de l'eau
seulement et 35.2% n'avaient ni eau, ni savon ou autre détergent pour se laver les mains
(EDS, 2014). En termes d'assainissement, des efforts importants restent à faire au Sénégal
puisqu'en milieu rural, 34% de la population a accès à des latrines améliorées; 42% utilisent
des latrines non améliorées (dont 8% utilisent des latrines partagées) et 24% pratiquent la
défécation à l’air libre (DAL; WHO/UNICEF, JMP, 2015).
L'hygiène et l'assainissement sont donc des priorités du gouvernement sénégalais,
notamment avec la mise en place du Programme d'Eau Potable et d'Assainissement du
Millénaire (PEPAM). Cependant, 7 ans après son lancement, les progrès dans l'accès à
l'assainissement en zone rurale restent insuffisants, l'accès à l'assainissement améliorée
passant de 26.2% en 2005 à 35.2% en 2012 (Rapport Annuel, PEPAM, 2013). La DAL reste
importante malgré l'augmentation des initiatives d'Assainissement Total Piloté par la
Communauté (ATPC) depuis 2009. Il apparaît donc que le pays n'atteindra pas les Objectifs
du Millénaire pour le Développement (OMD) fixés à 65% pour ce qui est de la part de la
population utilisant des latrines améliorées en 2015.
Le Ministère de l'Eau et de l'Assainissement a donc sollicité le Programme Eau et
Assainissement (PEA) de la Banque Mondiale pour qu'il apporte son appui technique au
gouvernement sénégalais, afin de soutenir le renforcement de l'assainissement en milieu
rural, notamment en engageant davantage les gouvernements locaux et de mieux cibler les
communautés.
Dans le cadre de l'appui à son programme se rapportant à l'amélioration de l'offre et la
demande en matière d'hygiène et d'assainissement au Sénégal, le PEA a alors mandaté
l'Institut Tropical et de Santé Publique Suisse (Swiss TPH) pour conduire une enquête
ménage au niveau national. Cette enquête a été complétée par une approche qualitative
incluant des entretiens avec des informateurs privilégiés et des focus groupes.

Objectifs
Ce mandat vise à conduire une “enquête auprès des ménages pour évaluer les
comportements d'hygiène et d'assainissement ainsi que la volonté de payer en milieu rural
au Sénégal”.
Les résultats de cette étude devront aider le PEA et ses partenaires à développer des outils
de changement de comportements et de communication à partir d’éléments probants, avec
un accent mis sur l’amélioration des pratiques d’assainissement et d’hygiène. Le but est de
susciter durablement la demande des communautés rurales et de développer l’offre
correspondante en services améliorés d’hygiène et d’assainissement à l’échelle du pays.
Plus spécifiquement, les objectifs de cette recherche sont les suivants:
 Estimer la disponibilité des latrines améliorées au niveau des ménages, leur utilisation,
leur entretien, le lavage des mains ainsi que les pratiques d'évacuation des selles
(incluant celles des jeunes enfants).
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