Re-thinking sanitation approaches on a small atoll: Can they foster hygiene behavior change?

Re-thinking sanitation approaches on a small atoll: Can they foster hygiene behavior change?

South Tarawa residents suffer a high prevalence of waterborne diseases.

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For many years it was thought that sanitation problems could be tackled by simply building toilets, sewers and treatment plants. The need for behavior change among end-users was rarely, if ever, considered, and at best saw health campaigns hastily tacked on to, what were essentially, hardware projects.

Written by Allison Woodruff, Urban Development Specialist

For many years it was thought that sanitation problems could be tackled by simply building toilets, sewers and treatment plants. The need for behavior change among end-users was rarely, if ever, considered, and at best saw health campaigns hastily tacked on to, what were essentially, hardware projects. As a result, supply-led sanitation models have largely failed to deliver sustained improvements in public health and environmental quality.

Kiribati has been the recipient of several large externally-funded sanitation projects over the last two decades. The first large project, which saw the construction of sewerage systems and public and communal toilets in densely populated areas of South Tarawa was launched in the early 1980s in response to an outbreak of cholera. However, the sewerage system subsequently fell into disrepair and underwent extensive rehabilitation in the early 2000s. The sanitation infrastructure is again severely dilapidated - communal toilets sit filthy and abandoned, and private toilets no longer function as originally designed.  

Traditionally in Kiribati, like many other parts of the world, the ocean has been the preferred place for defecation. In Gilbertese, the language of the Gilbert Group of islands in Kiribati, the word for toilet, ‘te kainnako taari’ literally means ‘go to the sea’. In populated urban centers in South Tarawa, this practice constitutes a serious threat to public health through contamination of the atoll’s water table. Although technically illegal, the ban on open defecation is not enforced. According to the results of the 2010 census, around one quarter of the population of South Tarawa still engages in open defecation. 

The reality is that old habits die hard, and sanitation experts around the world have been looking to other disciplines for guidance on changing behavior. 

Advertizing approaches can offer many insightful lessons for development practitioners. It is not surprising that hygiene campaigns that have focused on the public health and environmental benefits of sanitation alone have had little impact on behavior change. Consider ad campaigns used by gyms. We all know that exercise can prevent diabetes and cardiovascular disease, but we don’t always do what is good for us. So instead these ads focus on what is more immediately appealing to the average person - that working out can give you a leaner or more muscular physique. Similarly, the private motivation for investing in sanitation, which may include convenience and social status, is very different from the wider societal benefits that policy-makers and development practitioners are concerned about.  

Similarly, companies have successfully created demand for personal care products by convincing consumers that if they do not use a particular brand of toothpaste or mouthwash, they will risk becoming social outcasts with their bad breath. 

Recently-developed total sanitation approaches are building on these approaches, which rely on the use of peer pressure, and feelings of disgust or shame to motivate households to invest in toilet construction. This has resulted in the creation of thousands of ‘open defecation free’ villages around the world. In the same way, supply of sanitation hardware has moved beyond ‘one-size-fits all’ approaches. Sanitation marketing focuses on making available through the private sector, a range of sanitation hardware products that appeal to the different needs, preferences and incomes of heterogeneous groups of users. 

The $22.5 million South Tarawa Sanitation Improvement Sector Project is being supported by the Asian Development Bank with grant co-financing from the Australian Agency for International Development. The project includes an extensive community engagement program to build demand for improved sanitation and promote sustained behavior change among households. Sustainability will also be enhanced by capacity building to manage the sanitation infrastructure and private sector participation in the operations and maintenance of sanitation systems.