Attachment 3_AID-696-A-16-00008 - Barrier Analysis Final.pdf

Submission Date: March 30, 2018

Cooperative Agreement Number: AID-696-A-16-00008

Submitted to: AOR, Nicole Mukunzi

Submitted by: Eveline Viegas, Chief of Party

SNV USA

Queen’s Land House, KG 563 Street, BP 1049 Kigali - Rwanda

Tel: +250 781 849 876 Email: eviegas@snvworld.org

ISUKU IWACU

BARRIER ANALYSIS ON

HOUSEHOLDS LATRINES’

CLEANLINESS FOR ISUKU IWACU-

RWANDA RURAL SANITATION

ACTIVITY (RRSA)

Contents

1. Abbreviations and Acronyms

2. Acknowledgements

3. Executive Summary

4. Background Information

5. Objectives of the barrier analysis

6. Data collection and methodology

Questionnaires

Sampling of villages for data collection

Field data collection in villages

7. Schedule of activities

Proposed budget for the activity

8. Demographical Information for Four Districts

9. Comparison of Doers and Non-Doers Across Four Districts

10. Latrine Cleaning: District Comparison Of Doers And Non-Doers

11. Barrier Analysis Per Each District

Nyanza

Ngoma

Nyabihu

Nyarugenge

12. Average Barrier Analysis for Four Districts

13. Results and Conclusion

15. Bridge Activities Per District

Nyanza District

Ngoma District

Nyarugenge District

Nyabihu District

16. Full Tabulation Results: Nyanza District

17. Full Tabulation Results: Ngoma District

18. Full Tabulation Results: Nyarugenge District

19. Full Tabulation Results: Nyabihu District

20. Average Barrier Analysis for Combined Districts

Nyanza, Ngoma, Nyabihu and Nyarugenge

21. Questionnaires

1. Abbreviations and Acronyms

BA : Barrier Analysis

CHC : Community Health Centre

CHC : Community Health Club

CHW : Community Health Worker

CRS : Catholic Relief Service

HH : Household

JMP : Joint Monitoring Program

NISR : National Institute of Statistics of Rwanda

RRSA : Rwanda Rural Sanitation

RwF : Rwandese Francs

UNICEF : United Nations Children’s Fund

USAID : United States Agency for International Development

WASH : Water, Sanitation and Hygiene

WHO : World Health Organization

2. Acknowledgements

3. Executive Summary

Background. The Rwanda Water and Sanitation Policy (2010) estimate the sanitation coverage to 45%. Through Vision 2020 and EDPRS II, Rwanda aspires to have 100% water supply and sanitation coverage by 2018. Nationwide, 62 percent of the population has access to an improved, non-shared toilet facility, according to the 2015 WHO/UNICEF Joint Monitoring Program (JMP) that monitored progress towards the Millennium

Development Goals. Recent Isuku iwacu baseline survey and formative research conducted in fiscal year 18, revealed that some sanitation indicators are still low in households of 8 districts of implementation.

Isuku Iwacu interventions in 8 Districts of implementation have increased the coverage of improved latrines in nearly all villages through the construction of improved latrines for vulnerable families, mobilization activities toward Open Defecation Free and Community Hygiene Clubs efforts. Some constructed latrines are often unclean and poorly maintained which can lead to underutilisation or abandon, with a corresponding rise in recidivism of open defecation. Poor access to cleaned latrines will result in poor sanitation and hygiene and this can lead to diarrheal disease, resulting in inefficient absorption and under nutrition. In order to address challenges mentioned, Isuku Iwacu is conducting the barrier analysis to explore real causes of unclean and poorly maintained latrines and to better understand the specific challenges of maintaining clean latrines1 in communities of Isuku Iwacu implementation.

Methodology: One questionnaire was priory developed for the analyzed behavior. Questions are associated to determinants for the desired behaviour being promoted by Isuku Iwacu activities. First section of the questionnaire will help to determine if a respondent is a Doer or a Non-

Doer and then 1 to 2 questions are developed for each of the determinants being studied for the behavior, the questionnaire will be pre-tested on a few members of the target group to assure that questionnaires is understandable and effective.

Analysis. Field staff collected and manually tabulated the data for this project and analysed it using a standard BA tabulation Excel sheet. A 10% percent difference was used to determine significant differences in responses among doers and non-doers. The Barrier Analysis, tabulation Excel sheet conducts a statistical analysis to determine if the difference between doers and no-doers is statistically significant.

Results A total of six determinant questions were asked, but only self-efficacy and social norms were strongest determinants that can best answer why non-doers are not cleaning their latrines. For self-efficacy, non-doers were asked two questions: What makes it easier or difficult to clean your latrines at home? Non-doers responded:1) water and ashes make it easier for them to clean their latrines and: 2) disability, old age, culture and lack of time makes it difficult to clean their latrines. For social norms, non-doers were asked two questions: Who are the people with the most favorable or unfavorable opinion of you cleaning your latrines at home? Non-doers responded:1) teachers are the people with the most favorable opinion of them cleaning toilets and: 2) neighbours were a perceived source of negative influence. When non-doers and doers are compared, non-doers were likely to mention ashes more than soap whereas doers were likely to mention soap. Results show that non-doers perceive teachers more than community health workers to be the people who positively encourage them to clean their latrines. On other hand.

doers perceived community health workers and community health centres as a source of positive influence in cleaning latrines.

In terms of latrine cleaning, the following graph shows the comparison results per district.

Figure 1: Latrine Cleaning Comparison Per District

Latrine Cleaning Results Discussion: Across all four provinces, Ngoma district has the highest number of both doers and non-doers who clean and don’t clean their latrines. Ngoma has the highest number of non-doers likely because it has relatively a high number of non-doers with disability (14%) as shown by this BA, which makes it difficult to clean latrines. The issue of disability was also confirmed by the data from National

Institute of Statistics Rwanda, which determined that Ngoma is among the districts with a high percent of people with disability at 3.3%. Ngoma district also has the highest number of doers, though data from NSR indicated that 86.1% of people are unemployed, only 32.5% have access to water, and many walk about an hour to access health and basic resources. Nevertheless, something vital to note about Ngoma district is its access to 12 health centres and 13 health posts per population of 323,000. From this information, we can conclude that people in Ngoma are convinced that cleaning their latrines is beneficial for their community, hence they clean their latrines despite the challenges they face in terms of access to resources. In addition, BA results revealed that Ngoma has the highest number of non-doers (60%) who mention teachers as a source of positive

Executive Summary Continued

1 Cleaned latrines including covers

A cleaned latrine needs to meet all criteria for a basic sanitation, which is defined according to the JMP, as a sanitation facility that hygienically separates human excreta from human contact, and that is not shared with other HHs. The latrine is therefore considered clean: neither liquids, flies, dirt, paper nor mud is visible within the squatting area of the toilet. Minor liquids and/or paper is acceptable if found in the corners. Septic system or pit latrine with slabs needs to have a cover to be considered fully clean.

308 277

D O

E R

S

N O

N

D O

E R

S

D O

E R

S

N O

N

D O

E R

S

D O

E R

S

N O

N

D O

E R

S

D O

E R

S

N O

N

D O

E R

S

NYANZA NGOMA NYARUGENGE NYABIHU

Total Number of Doers and Non-Doers

Who Clean Toilets

Per District

Across all four provinces, Ngoma district has the highest number of both doers and non-doers who clean and don’t clean their latrines.

Nyarugenge province has the second highest number of doers who clean toilets and has the least number of non-doers who do not clean toilets.

Nyanza province has the third highest number of doers who clean their toilets and second highest with non-doers who do not clean their toilets.

Nyabihu province has the least number of doers who clean toilets and is also second highest with non-doers who do not clean toilets.

influence compared to Nyanza, Nyarugenge and Nyabihu. This could mean that the children of non-doers are receiving some form of health education from school and are sharing it with their parents, who many not be necessarily motivated to clean latrines.

Nyadenge province has the second highest number of doers who clean toilets and has the least number of non-doers who do not clean toilets.

According to the National Institute of Statistics Rwanda, 90% of the population in Nyarugenge district are employed and 94% have access to water and only 9% of people are unemployed. Nyarugenge also has the highest number of health centres (10) and health posts (62) among the four districts. In general, Nyarugenge has better access to resources compared to Nyabihu, Nyanza and Ngoma districts. This data confirms the BA results that indicated Nyarugenge to have the least number of non-doers. We should also note that Nyarugenge has 2.7% of people with disability, which is second high from Ngoma (3.3%) and perhaps, some of these non-doers are part of this 2.7%.

Nyanza province has the third highest number of doers who clean their toilets and second highest with non-doers who do not clean their toilets.

According to the BA results, Nyanza district has the highest district number of non-doers who mention disability (24%) and doers (4%) compared to other three districts. This BA result is confirmed by the NSR, which indicated that Nyanza has 6.7% of people with major disability and is the second highest district in the country. The NSR also indicates that Nyanza ’s access is below the national expectation; 28% people live in extreme poverty and half of the population lives in poverty and is first place with highest percent of orphans in the country. However, 82% of population is employed in agricultural jobs, but most working groups are youth aged 16. In addition, school attendance is low, despite that in this BA, non-doers mentioned teachers (58%) to be a source of positive influence in latrine cleaning. Despite Nyanza’s poor access to resources, it does have good access to health centres (17) and health posts (30) compared to Nyabihu and Ngoma. Nyanza is second highest from Nyarugenge with more health posts and health centres. In addition, our BA results showed that Nyanza is the only district with a higher percent of non-doers with old age (53%) compared to other three districts. As a district, Nyanza is doing well in terms of latrine cleaning compared to Nyabihu district, which has 70-80% access to water and other resources that advantages that Nyanza doesn’t have.

Nyabihu province has the least number of doers who clean toilets and is also second highest with non-doers who do not clean toilets. Surprisingly, Nyabihu has about 70-80% access to water and are within 15minute walking distance from the next source of water. Under this revelation, we expect Nyabihu to have the highest number of doers, but it is not the case. According to the National Institute for Statistics Rwanda, Nyabihu has 1.6% of disability, which is lowest among the four districts. This is confirmed by our BA as this district has the lowest number of non-doers

(2%) who mention disability as a barrier to cleaning their latrines. For this district, it should be noted that it has the highest number of non-doers who mention lack of time (40%) as reason for not cleaning their latrines.

The graphs below show and summaries the average analysis for the chosen two determinants (social-norms and self-efficacy) that best show why non-doers aren’t cleaning their latrines.

Water Soap Ash

DOERS NON-DOERS

PERCEIVED SELF-EFFICACY

What Makes it Easier to Clean

Total NonDoers(166)Total Doers(210)

AVERAGE

ANALYSIS

ALL DISTRICTS

Elderly Culture No Time Disability

PERCEIVED SELF-EFFICACY

What Makes it Difficult to Clean Latrines

DOERS NON-DOERS

Total Doers(75) Total Non-Doers(95)

AVERAGE

ANALYSIS

ALL

DISTRICTS

This graph shows that non-doers are more concerned with water and ash.

Non-doers are more concerned with lack of time, disability and old age compared to doers.

Executive Summary Continued

Introduction: The graphs below summarise the average analysis for the chosen two determinants (social-norms and self-efficacy) that best answer why non-doers aren’t cleaning their latrines.

Discussion: Beyond the issues that non-doers and doers perceived as challenges to cleaning latrines, two questions that must be answered: Why are doers motivated to continue cleaning their latrines despite these challenges? And why are non-doers not cleaning their toilets and what exactly do they lack? There are three possible reasons why doers are motivated to clean their latrines despite the challenges they face:1) they likely believe their susceptibility to disease is high, 2) latrine cleaning is customary and habitual for them, and:3) it could be that community leaders punish community members who do not clean their latrines. Secondly, there are three possible reasons why non-doers are not cleaning their latrines:1) they believe their susceptibility to disease is low (though in actuality it is high), 2) they prioritise self-sustenance over latrine cleaning, and 3) they simply lack motivation to clean latrines. These assumptions are an attempt to think beyond the challenges non-doers mentioned as barriers to cleaning their latrines. And there could be more factors beyond the ones mentioned.

Project Revelations: The first revelation is that non-doers lack good access to water and money to buy cleaning materials. Because of this, it is likely that non-doers are prioritising self-sustenance over latrine cleaning.

The second significant revelation is the issue of old age, disability, lack of time, and culture, which makes it difficult for non-doers to clean their latrines. Both non-doers and doers across all provinces perceived disability and old age as hindrances to cleaning their latrines. For these specific issues, people of old age and those with a disability must be prioritised in latrine cleaning activities. An opportunity for action is to form a committee of helpers who can help the elderly and disabled with latrine cleaning.

The third revelation is the positive influence teachers have on non-doers. Non-doers were likely to mention teachers and community health centres as a source of positively influence. Three conclusions can be made from thsi:1) the presence of community health workers is low in places where there is a high number of non-doers, 2) it is possible that the children of non-doers are receiving sanitation and hygiene education from school and share that knowledge with their parents and 3) it could be that teachers are acting as agents of positive change and advocates of latrine cleaning within the community. An opportunity for action is to make children/youths a priority and target population for latrine cleaning activities in the community. Attention can be also focused on engaging teachers in latrine cleaning activities and efforts.

The fourth revelation is that non-doers perceive lack of time as something that makes it difficult for them to clean their latrines. Lack of time can possibly mean that non-doers perceive cleaning latrines to be a waste of time and not a priority. The big question is, what is it that non-doers are devoting their time on? Is it that they are devoting their time in activities that bring them sustenance at home?

The fifth revelation is that both non-doers and doers perceive culture to make it difficult for them to clean their latrines. For culture, it could be about their perception on the value of latrines. Culturally, non-doers could be perceiving the toilet as a place where they simply “dump dirt” and needs no cleaning. If this is true, non-doers place less value on the latrine itself, which influences them to not clean it. The last significant revelation is neighbours being the source of negative influence for non-doers. Here, the issue could be about communal/sharing toilets. The likelihood of shared toilets being dirty is high. And people may commit to cleaning an owned latrine than a public latrine. Encouraging communities’ members to build their own latrines might be the solution.

Executive Summary Continued

COMMUNITY

HEALTH

CENTRES

COMMUNITY

HEALTH

WORKERS

NEIGHBOURS TEACHERS

PERCEIVED SOCIAL-NORMS

Encourages Cleaning Latrines

DOERS NON-DOERS

AVERAGE

ANALYSIS

ALL DISTRICTS

Total Doers(244) Total No-Doers(191)

Elderly Culture No Time Disability

PERCEIVED SELF-EFFICACY

What Makes it Difficult to Clean Latrines

DOERS NON-DOERSTotal Doers(75) Total Non-Doers(95)

AVERAGE

ANALYSIS

ALL DISTRICTS

Teachers and community health centres are a source of positive influence for non-doers.

Non-doers are concerned with disability, lack of time and old age.

Opportunities of Action:

From the BA results, there are opportunities of action to be considered in ensuring that people have the resources needed to clean their latrines.

The first opportunity of action is to increase water access to districts with water scarcity. If people have less access to water or fetch their water far from where they live, the likelihood of them using that water to clean latrines is low. Rather, they will use it for drinking and cooking. Secondly, consider income generating activities for community members to earn money to purchase cleaning materials and this would also help them with providing for their family. Do so while at the same time engaging them in latrine cleaning activities. Third, increase more sanitation education in communities, emphasizing how dirty toilets make communities highly susceptible to disease. Fourth, people of old age and with disability must be prioritized in latrine cleaning activities. And consider forming a committee of helpers who assist this population with latrine cleaning. Fifth, children and youths must be prioritized in latrine cleaning activities because they are likely to serve as positive influencers among their peers and likely to clean toilets compared to adults. Sixth, continue emphasizing the use of ashes to reduce toilet flies and the making of woven toilet covers/lids to reduce flies and toilet smell. Lastly, identify motivation factors and triggers that encourage community members to clean their latrines.

Project Gaps and Limitations

Beyond the determinants that were assessed to identify factors contributing to lack of latrine cleaning, this project has some limitations. The first limitation is lack of gender assessment data specifically showing the exact number of respondents who were non-doers and doers or children

(boys or girls). With this data, results could have showed us the specific gender of non-doers and doers. It could have been that most non-doers are females, since it’s most women and girls who perform domestic work at home compared to men or boys.

The second limitation is that not many determinants were tested. For example, we believe that the community’s belief in their susceptibility to disease can reveal reasons behind non-doers not cleaning latrines.

The third limitation is that this BA project is not representative of all people within the identified districts. The sample size for the BA analysis was relatively small per each district.

These limitations are possible confounding factors to why non-doers aren’t cleaning their latrines.

Conclusion:

There are several conclusions we can made from the BA results. The first conclusion is that the issue of latrine cleaning is about access to resources such as water and cleaning materials and other related needs. However, this issue is beyond access to resources. As the BA revealed, many non-doers have disability, old age and likely lack basic needs to sustain themselves. It could also be that people simply do not like cleaning latrines and are making that choice. For instance, Nyanza district had the second highest of doers, but half of its population lives in poverty, access to water is below average, orphan hood is high, and disability is high. But Nyabihu, which has more than 70% access to water and employment is high, disability is low, has the least number of doers. Could this mean cleaning latrines is perceived as a matter of choice? Is it necessarily all about lack resources?

The second conclusion is that community leaders within these communities likely do not clean their latrines or they don’t have latrines. If leaders lead by example, the whole community has positive models to follow. Therefore, latrine cleaning activities must ensure that community leaders are in fact cleaning their latrines and have latrines themselves, before telling the mass to clean their latrines.

The fourth conclusion is that positive language matters. If community leaders and community health workers continue to use positive language around latrine cleaning, non-doers may be encouraged to clean their toilets. Also, community health workers at health centres or who live within these communities must also clean their latrines, this way community members will likely listen to their messages about latrine cleaning.

4. Background Information

The Rwanda Water and Sanitation Policy (2010) estimate the sanitation coverage to 45%. Through Vision 2020 and EDPRS II, Rwanda aspires to have 100% water supply and sanitation coverage by 2018.

Nationwide, 62 percent of the population has access to an improved, non-shared toilet facility, according to the 2015 WHO/UNICEF Joint

Monitoring Program (JMP) that monitored progress towards the Millennium Development Goals.

Through analysing and interpreting information collected by USAID funded baseline survey conducted by CRS within the scope of Gikuriro activity, October 2016 in 6 Districts (Kayonza, Rwamagana, Ngoma, Nyarugenge, Kicukiro, and Nyabihu), potential sanitation risk practices were documented and for instance it reveals that 32 percent of respondents do not have improved sanitation facilities.

Recent Isuku iwacu baseline survey and formative research conducted in fiscal year 18, revealed that some sanitation indicators are still low in households of 8 districts of implementation.

Interviews were carried out in households, and the report reveals that 49.3 percent of respondents were heads of households and that 37.6 percent were their spouses, which means that survey results are proportionally reflecting the actual perceptions of heads of households or/and their spouses. 27.3 percent of heads of households did not achieve any schooling level, 26.4 percent did some primary and 25.9 percent finished primary.

Gender, about 68.9 percent of respondents were of male sex and 31.1 percent were of female sex.

Gender Equality and Norms in Rwanda

According to the Global Gender Gap Report 2014, which measures women’s economic participation and opportunity, education, political empowerment, and health and survival, Rwanda is ranked seventh in the world for gender equality.2 As a country, Rwanda has been making strides in promoting gender quality and deconstructing the various systems of oppression toward women that are often fuelled by patriarchal attitudes.3

With 64% of women in parliamentary cabinet positions after 2013 elections, this is evidence to point to Rwanda’s progress in ensuring that women are empowered and included in decision-making and political leadership positions4. Despite this progress that Rwanda has made, gender inequality persists in the country, especially for poor women who live in areas. “Women are expected to adopt a domestic and depend role within the family; girls are to help their mothers with household chores, bear male children and be reliant on the patriarchal figures in their lives.5” On the other hand, men are seen as the breadwinners for their families and their job rarely involves domestic work.6 This is speaks volume to the fact that women continue to experience gender inequality in all aspects of their lives compared to men.

As far as latrine’s cleanliness status is concerned, Of 2,101 HHs having latrines, only 1,009 HHs (48%) have clean latrines where floors or slabs are not contaminated with faeces or urine and latrines in 452 HHs (22%) have no covers available; flies were visible in 192 latrines (9%).

847 HHs out of 1,071 HHs (79%) safely dispose faeces of their youngest children under 3 years of age; with regard to children faeces disposal practices, this survey revealed that faeces are buried, dropped in public latrines or rinsed away; these practices are unsafe. Clean latrines are found mostly in categories 2 and 3.

When analysing the percentage of HHs members who use the latrine at home, it shows that in 99% of the HHs owning a sanitation facility, it is used by all members of the HHs (including men and women, boys and girls, elderly, people with disabilities).7

As long all members at the households’ level are using latrines, and as the cleanliness status seems to be inappropriate; the HHs members (males and females, elderly, people with disabilities of age 18 to 60) should ensure regular cleanliness of their latrines as the way they all use them.

The above paragraph is clearly showing that HHs members (males and females, elderly, people with disabilities of age 18 to 60) should be defined as the priority group to be considered by this barrier analysis.

5. Objectives of the barrier analysis

2 Nizeyimama, Jean. “Rwanda is Ranked Seventh by the Global Gender Gap Report for Gender Equality.” UMUSEKE. 28, October, 2014. Web 3 Gender Analysis for USAID/Rwanda Valuing Open and Inclusive Civic Engagement Project January 2015, p.9 4 https://www.unwomen.org/en/news/stories/2018/8/feature-rwanda-women-in-parliament 5 Uwineza, Peace and Elizabeth Pearson. “Sustaining Women’s Gains in Rwanda.” Institute for Inclusive Security, 2009. Web. 21 6 ibid 7 Isuku Iwacu baseline survey, September 2017 https://www.unwomen.org/en/news/stories/2018/8/feature-rwanda-women-in-parliament

Isuku Iwacu interventions in 8 Districts of implementation have increased the coverage of improved latrines in nearly all villages through the construction of improved latrines for vulnerable families, mobilization activities toward Open Defecation Free and Community Hygiene Clubs efforts.

Some constructed latrines are often unclean and poorly maintained which can lead to underutilisation or abandon, with a corresponding rise in recidivism of open defecation. Poor access to cleaned latrines will result in poor sanitation and hygiene and this can lead to diarrheal disease, resulting in inefficient absorption and under nutrition.

In order to address challenges mentioned, Isuku Iwacu is conducting the barrier analysis to explore real causes of unclean and poorly maintained latrines and to better understand the specific challenges of maintaining clean latrines8 in communities of Isuku Iwacu implementation.

The general objective of this barrier analysis is to complement the previous Isuku Iwacu baseline and formative research results by assessing the underlying reasons around maintaining clean latrines, understand which barriers / determinants are the most influential in motivating or preventing household’s members from adopting the desired behaviour of maintaining clean latrines.

The analysis will establish detailed information about households’ members, defined so far as the primary priority group, current behaviours as well as barriers to intended desired feasible behaviours to be prioritized by Isuku Iwacu activities toward our primary group;

6. Data collection and methodology

a. “Adults (males and females of age18 to 60) ensure regular cleanliness of their households’ latrines”. As Isuku Iwacu baseline results show that all members at the households’ level are using latrines, and as the cleanliness status seems to be inappropriate;

which justify that the HHs members (males and females, elderly, people with disabilities of age 18 to 60) should ensure regular cleanliness of their latrines as the way they all use them.

The current barrier analysis will help also to define thoroughly the secondary target audiences and third target audience.

Questionnaires One questionnaire was priory developed for the analyzed behavior. Questions are associated to determinants for the desired behaviour being promoted by Isuku Iwacu activities.

First section of the questionnaire will help to determine if a respondent is a Doer or a Non-Doer and then 1 to 2 questions are developed for each of the determinants being studied for the behavior, the questionnaire will be pretested on a few members of the target group to assure that questionnaires is understandable and effective.

Sampling of villages for data collection Our study will be conducted in households and for the representativeness of results, it will draw respondents from different villages whereby interviews will be done for 45 Doers and 45 Non-Doers for each behavior from each of 4 districts targeted (Ngoma, Nyarugenge, Nyanza and

Nyabihu Districts).

9 villages are selected randomly and fairly from 3 cells of 3 sectors within each district (3 villages from 1 cell per 1 sector). In each cell, 30 households will be randomly selected to be interviewed for the behavior (45 doers and 45 non doers /cell per sector).

The table below show the list of villages in which Isuku iwacu formative research will be conducted, the villages are sampled from Isuku iwacu baseline survey areas (Table a).

District Sector Cell Village Households to be interviewed

NGOMA ODF 30

Voucher 30

CHC 30

NYARUGENGE

ODF 30

Voucher 30

CHC 30

NYANZA ODF 30

Voucher 30

CHC 30

8 Cleaned latrines including covers

A cleaned latrine needs to meet all criteria for a basic sanitation, which is defined according to the JMP, as a sanitation facility that hygienically separates human excreta from human contact, and that is not shared with other HHs. The latrine is therefore considered clean: neither liquids, flies, dirt, paper nor mud is visible within the squatting area of the toilet. Minor liquids and/or paper is acceptable if found in the corners. Septic system or pit latrine with slabs needs to have a cover to be considered fully clean.

NYABIHU ODF 30

Voucher 30

CHC 30

Field data collection in villages

Each of three teams (three data collectors per each) is assigned to carry data collection by interviewing 10 households members per day for the analyzed behavior (5 questionnaires for Non Doers and 5 for Doers), 90 households’ members will be interviewed for each behavior and for each of 4districts using tablets.

Training of enumerators and pretest of questionnaires will be done in one day and the data collection will be conducted in 4 days.

5. Data entry and analysis of results

Two (2) days for data entry and Three (3) days for analysis are planned; results will be tabulated using a coding guide and the percentage will be calculated using excel sheet.

The responses between Doers and Non Doers for each determinant assessed, with a 15% point difference or higher will indicate most significant determinants to be based on while defining and planning focused Isuku Iwacu behavior change communication activities to improve the cleanliness of latrines.

7. Schedule of activities The work will be completed over a period of 10 working days with the following break up, the proposed dates are subjected to change

No Sub activities Duration Period

1 Preparations for data collection 2 days April 09-12, 2019

2 Training and pretest 1 day April 16, 2019

3 Field data collection 4 days April 22-26, 2019

4 Tabulation + Analyzing results 4 days April 29-May 3rd , 2019

5 Report writing (draft of analysis and narrative report )

3 days May 6-10, 2019

Proposed budget for the activity

Item

# of person # of days unity Price Total

Cost for data collection

Translate the questionnaire 1 2 100,000 200,000

Programming tablets 9 2 250,000 500,000

Airtime for data collectors 6 4 2,000 48,000

Airtime for team leaders 3 4 2,500 30,000

Refreshment for SEDO 3 4 5,000 60,000

Sub/Total 838,000

Transportation cost car renting for pretesting questionnaire 3 1 80,000 240,000 car renting for data collection 3 4 80,000 960,000

Sub/Total 1,200,000

M& I allowances

Accommodation 10 3 30,000 900,000

Sub/Total 900,000

Cost for data analysis

Small conference room 9 4 50,000 200,000

Lunch 9 4 6,500 234,000

Sub/Total 434,000

Total 3,372,000

8. Demographical Information for Four Districts

Nyabihu and Ngoma

Nyabihu District: Demographical Data9

Ngoma District Demographical Data10

Nyabihu

Population estimated=323, 719

Females=52.4%

83.6% is less than

40years

Health Centres=16

Health Posts=20

Hospitals=1

Nyabihu

Water Source

70%-80% of households have improved drinking water source within less than 15 minutes’ walk of an improved water source.

Ngoma

Population estimated 323,000

About 53% of the Ngoma population is female.;

about 55% are 19 or younger while about 83% are still under 40

People aged 65 years and above make up only 4% of the population, making this district a particularly youthful one

Ngoma

Water Source use an improved drinking water source

(67.6%).

40.7% use a protected spring, followed by a public standpipe

(21.8%); 5% use other improved water sources

However, 32.5% of households in this district still use an unimproved drinking water source.

Ngoma

Health Centres=12

Health Posts=13

Hospitals=1

Poverty Levels

28.6% is poor

Disability

1.6% of people have disability

Sanitation has 70.4% of households with access to improved sanitation facilities

Poverty Levels

About 52.4% of the population in Ngoma district is identified as non-poor

25.3% is poor (excluding extreme poor) and only

22.3% extreme-poor

Sanitation has 78.7% of households with access to improved sanitation facilities, which is above the national average

(74.4%).

Household leadership district is headed by females and 4.9% are de facto female-headed households.

Savings Account only 27.2% of households have at least one saving account

Employment

Agriculture and Jobs with 73.9% of all main jobs falling into this category;

having the highest percentage of land protected against soil erosion (94.1%).

Savings Account use of financial services show that 37.8% of households in

Ngoma district have at least one savings account

Unemployment overall employment rate is

86.1%

Walk to the Health

Centre mean walking distance to a health centre in

Ngoma district is 59 minutes; 51% of households walk for under an hour to reach a health centre

Disability

Ngoma has 3.3% of people with a major disability

Employment independent farmers

(73.5%) and agriculture is the main industry for 81.5% of the population aged 16 and above

9 National Institute of Statistics for Rwanda http://www.statistics.gov.rw/publication/eicv-3-nyabihu-district-profile 10 National Institute of Statistics for Rwanda http://www.statistics.gov.rw/publication/eicv-3-ngoma-district-profile http://www.statistics.gov.rw/publication/eicv-3-nyabihu-district-profile http://www.statistics.gov.rw/publication/eicv-3-ngoma-district-profile

Demographical Information for Four Districts

Nyanza and Nyarugenge

Nyarugende District Demographical Data11

Nyanza District Demographic Data12

Nyarugenge: Urban

Population is estimated at 282,000 about 49% of the population are aged 19 years or younger. About

52% of the population is constituted by female

Health Centres=10

Health Posts=62

Hospitals=1

Nyarugenge:

Water Source-

94% of Nyarugenge district households use an improved drinking water source

92% have access to improved sanitation facilities

Nyarugenge:

Nyarugenge district has the lowest employment rate among all districts

Nyanza: Rural

Sanitation and

Water with 89% of households having access to improved toilet facilities.

Below average in terms of water access. Water access is poor

Chore Time

Females still have to spend double the number of hours on domestic duties compared to males (24 hours and 12 hours respectively

Poverty level

About 90% of the population in

Nyarugenge district is identified as non-poor.

Sanitation has 70.4% of households with access to improved sanitation facilities

Disability has 2.7% of people with a major disability higher than national average which is

4.5%

Poverty level half of the households in

Nyanza are poor

28% that live in extreme poverty characterised by high poverty levels

Orphan hood

First place of orphan hood in the whole country . has 4.6% of orphans with both parent decease

Distance to Clinic mean walking distance to a health centre in

Nyarugenge district is 25 minutes and 89% of households walk less than an hour on average to a health centre

Employment employment rate is 71% of the resident population aged 16 years and above in

Nyarugenge district; the unemployment rate is 9%

Savings Account only a third (30%) of households have at least one saving account

Source of income agriculture is the main economic activity and source of income, 80% of adults aged 16 years and above are underemployed

Savings Account

Financial services, 65.3% of households in

Nyarugenge district have at least one savings account

Chore Time median number of hours spent on all domestic duties by adults is 16 hours, where males spent six hours and females 24 hours

Distance to Clinic the mean walking distance for both schools and health centres is greater than the average at the national level long distances residents need to travel in order to access social services

School attendance

Literacy rates and current school attendance is below national average likely due to distance to access resources

Health Centres=17

Health Posts=30

Hospitals=1

Disability

6.7% of people have major disability higher than national average

11National Institute of Statistics for Rwanda http://www.statistics.gov.rw/publication/eicv-3-nyarugenge-district-profile 12 National Institute of Statistics for Rwanda http://statistics.gov.rw/publication/eicv-3-nyanza-district-profile http://www.statistics.gov.rw/publication/eicv-3-nyarugenge-district-profile http://statistics.gov.rw/publication/eicv-3-nyanza-district-profile

9. Comparison of Doers and Non-Doers Across Four Districts

Nyanza, Ngoma, Nyarugenge, Nyabihu

Introduction:

Below are venn diagrams showing high level of differences and similarities of doers and non-doers across the surveyed four districts.

Both non-doers and doers perceive prevention of disease and proper hygiene as the main advantage of cleaning toilets

Both doers and non-doers perceive the cause of disease to be the negative consequence of not cleaning toilets. The difference is that non-doers are concerned with bad odour whereas doers are concerned with the proliferation of flies

Both non-doers and doers perceive water and soap as needs that make it easier to clean latrines.

However, non-doers emphasise ashes more than doers

Comparison of Doers and Non-Doers Across Four Districts

Nyanza, Ngoma, Nyarugenge, Nyabihu

Introduction:

Below are venn diagrams showing high level of differences and similarities of doers and non-doers across the surveyed four districts

Both non-doers and doers responded lack of time and disability makes it difficult to clean latrines. The difference is that doers were also concerned with culture whereas non-doers were concerned with old age

Both non-doers and doers perceive neighbours as the group that discourages them to clean latrines. The only difference is that doers emphasise family as the source of negative influence and non-doers do not.

Both non-doers and doers perceive community health workers as the group that encourages them to clean latrines. The difference is that doers emphasise community health centres as the source of positive influence whereas non-doers emphasise teachers.

10. Latrine Cleaning: District Comparison Of Doers And Non-Doers

Nyanza, Ngoma, Nyarugenge, Nyabihu

Introduction:

In addition to the survey questions that people were asked, the following questions below were asked to determine whether a person is a doer or non-doer

Section A - Doer/Non-doer Screening Questions

1. Yesterday, did you clean the latrine at your home?

❑ a. Yes

❑ b. No � mark as Non-doer and pose question 1 in Section B

❑ c. Can’t recall/ won’t say � End interview and look for another adult

2. Thinking about yesterday, please tell me: how many times did you clean the latrine at your home? (This is just a reminder question and should not be used to classify.)

❑ a. 1 time

❑ b. 2 times

❑ c. 3 times

❑ d. 4 times

❑ e. 5 or more times.

3. Aside from water, did you use anything to clean the latrine yesterday?

❑ a. Yes

❑ b. No

❑ c. Does not know / no response � end the interview and find another mother

4. If yes, what did you use?

❑ a. Soap

❑ b. Ash

❑ c. Toilet brush

❑ d. Other (specify) ……………………………………………………………………………………..

DOER /NON-DOER CLASSIFICATION TABLE

Doer

(all the following)

Non-doer

(any one of the following)

Question 1 = a Question 1 = b, c

Question 2 = a,b,c,d,e Question 2 = NA

Question 3 = a Question 3 = b, c

Question 4 = a,b,c,d Question 4 = NA

Results:

The following graph illustrates the total amount of people who clean toilets(doers) and those that do not clean toilets(non-doers) per each and combined surveyed district.

308 277

D O

E R

S

N O

N -D

O E

R S

D O

E R

S

N O

N -D

O E

R S

D O

E R

S

N O

N -D

O E

R S

D O

E R

S

N O

N -D

O E

R S

NYANZA NGOMA NYARUGENGE NYABIHU

Total Number of Doers and Non-Doers

Who Clean Toilets

Per District

DOERS NON-

DOERS

TOTAL PEOPLE

Total Doers And Non-Doers

Who Clean Latrines For

Combined Districts

11. Barrier Analysis Per Each District

Nyanza Nyanza

Introduction: The following bar graphs show the percentage of doers and non-doers’ responses per each determinant.

Perceived Positive Consequences

1. Perceived Negative Consequences

2. Perceived Self-Efficacy-Easier

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Prevent

Disease

Proper

Hygiene

Prevent

Smell Don't Know

%DOERS 98% 57% 15% 85%

%NON-DOERS 73% 27% 13% 31%

PERCEIVED POSITIVE CONSEQUENCES

Advantages of Cleaning Latrines

NYANZA

DISTRICT

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

It Causes

Disease Bad Odour

Flies

Proriferation

%DOERS 98% 52% 50%

%NON-

DOERS

78% 29% 40%

PERCEIVED NEGATIVE CONSEQUENCES

Disadvantages of Not Cleaning Latrines

NYANZA

DISTRICT

0%

10%

20%

30%

40%

50%

60%

70%

80%

Water Ash

%DOERS 72% 24%

%NONDOERS 42% 16%

PERCEIVED SELF-EFFICACY

What Makes it Easier to Clean Latrines

NYANZA

DISTRICT

Statistically, non-doers are 3.1(0.004, p <0.05) times to respond proper hygiene compared to doers.

Doers are 14.4 (0.000, p<0.05) times more likely to respond prevention of disease compared to non-doers

Doers are 9.7(0.000, p <0.05) times more likely to respond they don’t know compared to non-doers

The most significant determinants for perceived positive consequences are the prevention of disease, promotion of proper hygiene, and lack of knowledge

Statistically non-doers are 1.5(0.003,P<

0.05) times likely to respond bad odour as the disadvantage of not cleaning latrines compared to doers.

Whereas, doers are 2.4(0.020, p<0.05) times more likely than non-doers to respond the cause of disease as the disadvantage of not cleaning latrines.

Though proliferation of flies was statistically measured as insignificant (0.227, p>0.05), doers

(50%) and non-doers (40%) are strongly concerned with the proliferation of flies and perceive it as a negative consequence of not cleaning their latrines.

Statistically, doers were 3.1(0.004, p<0.05) times likely to respond water compared to non-doers

Though not statistically determined, non-doers also perceive water (42%) and ash (16%) as important in latrine cleaning

Therefore, the most significant determinant for both doers and non-doers is water.

Barrier Analysis Per Each District

Nyanza

3. Perceived Self-Efficacy-Difficult

4. Perceived Positive Influence

5. Perceived Negative Consequences

Elderly Don’t like No time Disability

%DOERS 11% 0% 30% 4%

%NONDOERS 53% 13% 36% 24%

0%

10%

20%

30%

40%

50%

60%

PERCEIVED SELF-EFFICACY

What Makes it Difficult to Clean Latrines

NYANZA

DISTRICT

Community Health

Centre

Community Health

Workers Teachers

%DOERS 41% 70% 0%

%NONDOERS 40% 7% 58%

0%

10%

20%

30%

40%

50%

60%

70%

80%

PERCEIVED POSITIVE INFLUENCE

Who Encourages Latrine Cleaning

NYANZA

DISTRICT

0% 1% 2% 3% 4% 5% 6% 7% 8% 9%

10%

%DOERS %NON-DOERS

Neighbours 7% 9%

Neighbours

PERCEIVED NEGATIVE INFLUENCE

Who Discourages Latrine Cleaning

NYANZA

DISTRICT

Statistically, non-doers are 7.0 times (0.000, p<0.05) more likely to respond elderly (old age) compared to doers

Non-doers are 1.0 (0.006, p<0.05)) times more likely to respond that they don’t like to clean latrines compared to doers.

Non-doers are 13.1 times (0.000, p<0.05) more likely to respond they have no time to clean latrines compared to doers.

Non-doers are 4.4times (0.006, p<0.05) more likely to respond that disability makes it difficult to clean latrines than doers.

Doers are 15.4 (0.000, p<0.05) times more likely to respond that Community Health Workers encourage them to clean latrines.

Non-doers are 1.3(0.000, p<0.05) times more likely to respond that teachers encourage them to clean latrines

Though not statistically determined, both doers (41%) and non-doers (40%) also perceive the community health centre as a source of positive influence. One important thing to note in this graph is the mentioning of teachers as a source of positive influence for non-doers. The conclusion that can be made is that the children of non-doers are receiving some form of sanitation and hygiene education from school and share that knowledge with their parents.

Statistically, none of the variables were determined as significant likely due to low response rate and sample size. Nevertheless, the variable-neighbour-is still important as both non-doers and doers mention it as a source of negative influence in their communities.

Perhaps, the issue of neighbour has to do with the sharing of latrines in the community. Neighbours could be using toilets of their neighbours and leaving them dirty. This discourages the owners of the toilets from cleaning them.

Ngoma

Ngoma

6. Perceived Positive Consequences

7. Perceived Negative Consequences

8. Perceived Self-Efficacy-Easier

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Prevent Disease Proper Hygiene Prevent Smell

%DOERS 100% 48% 21%

%NON-DOERS 100% 42% 16%

PERCEIVED POSITIVE CONSEQUENCES

Advantages of Cleaning Latrines NGOMA

DISTRICT

It Causes

Diseases Bad Odour

Flies

Proriferation

%DOERS 90% 73% 60%

%NON-DOERS 95% 40% 51%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

PERCEIVED NEGATIVE CONSEQUENCES

Disadvantages of Not Cleaning Latrines

NGOMA

DISTRICT

Water Soap Ash

%DOERS 69% 40% 25%

%NON-DOERS 53% 23% 26%

0%

10%

20%

30%

40%

50%

60%

70%

80%

PERCEIVED SELF-EFFICACY

What Makes it Easier to Clean Latrines

NGOMA

DISTRICT

Statistically, doers are 2.4 times (0.031, p<0.05) more likely to respond prevention of disease as the advantage of cleaning latrines compared to non-doers

Though not statistically measured as significant, both doers (48%) and non-doers

(42%) perceive the promotion of proper hygiene as an advantage for cleaning latrines

In this graph, both non-doers and doers have the same level of knowledge and understanding of the benefits of cleaning latrines

Statistically, doers are 3.6 times (0.001, p<0.05) more likely to respond that bad odour is the perceived negative consequence of not cleaning latrines compared to non-doers

The graph also shows a high percentage of both non-doers (95%) and doers (90%) who strongly believe the negative consequence of not cleaning latrines in the causation of disease

Doers (69%) are also concerned about the proliferation of flies compared to non-doers. This shows that doers have knowledge about latrine flies causing diseases. Therefore, more education on how toilet flies can cause illnesses should be emphasized during health talks to non-doers.

Though these determinants (water and ash) were not calculated as significant since their p values were greater than 0.05, they are still important because both non-doers and doers mention them in high percentages.

69% of doers responded water makes it easier to clean latrines

53% of non-doers responded water makes it easier to clean latrines

40% of doers responded soap makes it easier to clean latrines

23% of non-doers responded soap makes it easier to clean latrines

Ngoma

9. Perceived Self-Efficacy -Difficult

10. Perceived Social-Norms-Positive Influence

11. Perceived Social-Norms-Negative Influence

Elderly Don’t like Culture No time Disability

%DOERS 13% 0% 23% 0% 6%

%NON-DOERS 5% 7% 0% 19% 14%

0%

5%

10%

15%

20%

25%

PERCEIVED SELF-EFFICACY

What Makes it Difficult to Clean Latrines

NGOMA

DISTRICT

Community Health

Centre

Community Health

Workers Teachers

%DOERS 40% 67% 0%

%NON-DOERS 42% 7% 60%

0%

10%

20%

30%

40%

50%

60%

70%

80%

PERCEIVED SOCIAL NORMS

Who Encourages Cleaning Latrines NGOMA

DISTRICT

0%

2%

4%

6%

8%

10%

12%

14%

Family members Neighbours

PERCEIVED SOCIAL NORMS

Who Discourages Cleaning Latrines

%DOERS %NON-DOERS

NGOMA

DISTRICT

Doers are 12.7(0.000, p<0.05) times more likely to respond culture makes it difficult to clean latrines compared to non-doers

Non-doers are1.5(0.002, p<0.05) times more likely to respond they lack time to clean latrines compared to doers

It is also important to consider disability (though the percentage is small) as a significant determinant since it’s a hindrance to cleaning latrines.

Doers are 13.4 times (0.000, p<0.05) more likely to respond community health workers as their source of positive influence compared to non-doers

Non-doers are 3.3 times (0.001, p<0.05) likely to respond teachers as a source of positive influence compared to doers

Non-doers mention teachers as their source of positive influence whereas doers mention community health workers and health centres as their source of positive influence. The fact that non-doers mention teachers could mean that community health workers are rarely present in their community to conduct health education on hygiene and sanitation. Whereas, for doers, they may have better access to health centers and community health workers.

Statistically, none of the variables were determined as significant likely due to low response rate and sample size.

Nevertheless, the variable-neighbour-is still important as both non-doers and doers mention it as a source of…