Attachment 4_AID-696-A-16-00008 Baseline Report.pdf

DISCLAIMER

The opinions and contents of this report are the sole responsibility of SNV and do not necessarily reflect the views of the United States Agency for International Development or the United States Government

BASELINE SURVEY REPORT

RWANDA RURAL SANITATION –

ISUKU IWACU ACTIVITY

February 2018

PHOTO: ISUKU IWACU

Report of baseline survey, February 2018 – USAID-funded Isuku Iwacu Activity i

Table of Contents

Acknowledgments ............................................................................................. iii Abbreviations and Acronyms ............................................................................ iv Executive Summary ........................................................................................... v

3.1 Key findings ...................................................................................................... vi

3.2 Conclusion and Recommendations ................................................................. xv

Rwanda Sanitation Context

4.1 Overall Sanitation Context

4.2 Sanitation context in targeted districts

4.2.1 Kigali City

4.2.2 Eastern Province

4.2.3 Southern Province

4.2.4 Western Province

4.3 Brief description of Isuku Iwacu

4.4 Objectives of the baseline survey

Methodology of the Baseline Survey

5.1 Field data collection

5.2 Sampling: size, villages, sectors and households

5.3 Data Analysis

Household Socio-economic Demographic Characteristics Current Access to Water

7.1 Source of Water

7.2 Availability of Water

7.3 Payment of Water

7.4 Treatment of Water

7.5 Water Storage

Current Access to Improved Sanitation

8.1 Technologies currently in use by latrine owners

8.2 Geological features of the latrine location of the household

8.3 Cleanliness of latrines

8.4 Amount spent by households on latrine construction and type of received external assistance

Current Status of Unimproved Sanitation

9.1 Type of latrines

9.2 Shared facilities

Defecation Practices

10.1 Defecation practices of adults and children

10.2 Distance from Household to defecation place

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10.3 Current practices of children’s feces disposal

Satisfaction with Current Defecation Practice Knowledge of Latrine Technologies and Geographic locations to Purchase

Materials Latrine Perception and Preferences

13.1 Perceived advantages

13.2 Perceived disadvantages

13.3 Favored features for preferred latrine

13.4 Latrine cost perception

Triggers for Latrine Adoption amongst Latrine Owners Latrine construction, Improvements and Emptying Practices

15.1 Construction process among latrine owners

15.2 Latrine improvements and emptying practices among latrine owners

15.3 Latrine construction intention by non-owners without any sanitation facility 69

Current Hygiene Status

16.1 Current Hand Washing Practice

16.2 Current access to knowledge on hygiene

16.3 Hygiene in the kitchen area

Communication Channels Currently Used Saving and lending practices and access to financing mechanisms

18.1 Household members involved in a community group

18.2 Saving and lending practices

18.3 Access to financing mechanisms

Current Gender Practices Summary of key recommendations References List of annexes

22.1 Annex 1: Supplementary tables

22.2 Annex 2: Latrine Types photos presented during the survey (Q4.15)

22.3 Annex 3: Pre-tested questionnaire

22.4 Annex 4: List of sectors, cells and villages where the baseline was conducted

22.5 Annex 5: List of participants in FDGs

22.6 Annex 6: List of key informants and stakeholders interviewed

22.7 Annex 7: HH location and GPS coordinates

List of tables List of figures iii

Acknowledgments

Isuku Iwacu would like to express gratitude to all who contributed to this report.

Particularly to Regional Consultancy team who designed the study, carried out field survey data collection and completed initial data analysis. Nastassha Arreza for participating in the data analysis process and final drafting of the report.

We also recognize the contribution of Ministry of Infrastructure (MININFRA), Ministry of Health (MOH), Ministry of local government (MINALOC), Water and Sanitation Corporation (WASAC) and United States Agency for International Development (USAID) who provided comments and feedback on draft reports.

We also acknowledge the valuable support provided by the district officials and local authorities of Kayonza, Kicukiro, Ngoma, Nyabihu, Nyanza, Nyarugenge, Ruhango, and Rwamagana districts where the survey data collection was conducted.

Also, this report would not have been a success without the invaluable support of the Isuku Iwacu team who dedicated significant time and effort in accompanying the researchers to the field and reviewed drafts of the report, and providing ongoing support to the survey implementation.

Finally, many thanks to the community members (Heads of Household) who took their precious time to answer questions.

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Abbreviations and Acronyms

BCC : Behavior Change Communication CHC : Community Health Club CHW : Community Health Worker CRS : Catholic Relief Service DHS : Demographic Health Survey EICV : Enquête Intégrale sur les Conditions de Vie des ménages FGD : Focus Group Discussions FXB : François-Xavier Bagnoud GOR : Government of Rwanda HH : Household IR : Intermediate Result JMP : Joint Monitoring Program MINALOC : Ministry of Local Government MININFRA : Ministry of Infrastructure MOH : Ministry of Health NISR : National Institute of Statistics of Rwanda ODK : Open Data Kit OR : Odd Ratio PHC : Population Housing Census PPS : Probability Proportional to Size RRSA : Rwanda Rural Sanitation RwF : Rwandese Francs SACCO : Saving And Credit Cooperatives SILCs : Saving and Internal Lending Communities SPSS : Statistical Package for the Social Sciences UNICEF : United Nations Children’s Fund USAID : United States Agency for International Development USG : United States Government VIP : Ventilated Improved Pit latrine VSLAs : Village Savings and Loan Associations WASH : Water, Sanitation and Hygiene WHO : World Health Organization v

Executive Summary

Background Access to sanitation facilities and the promotion of good hygiene practices are significant challenges in Rwanda. According to the 2014-15 Demographic Health Survey, 54% of households have access to improved toilet facilities, only 11.5% of households had a place for handwashing, 73% of households use an improved source of drinking water, and 49% of households spend 30 minutes or longer to collect water and return.

In response, the Government of Rwanda issued its 2016 National Sanitation Policy which aims to raise and sustain improved household sanitation coverage to 100% by 2018, and to promote hygiene behavior change. The NSP aims to create an enabling environment where there is individual demand (at the household level) for sanitation services, as well as a complementary market with available and affordable sanitation products.

In this context, the Isuku Iwacu Activity aims to contribute to improve access and encourage correct and consistent use of household sanitation and hygiene facilities.

The Isuku Iwacu Activity is being executed by a consortium of Non-Governmental Organizations headed by SNV, and including World Vision International and Water for People. The overall goal of the Isuku Iwacu Activity is to increase local ownership and capacity to deliver sustainable high-quality sanitation and hygiene services in order to decrease childhood stunting.

Objectives The purpose of this baseline survey is to establish a benchmark for the implementation of Isuku Iwacu activity and to provide baseline indicator results. These results will be used to measure the progress and effectiveness of the project from implementation to its completion on November 9, 2020.

The baseline survey collected information on households’ socio-economic demographic characteristics, access to and use of sanitation facilities and hygiene (including current behaviors, practices, barriers and constraints) in urban and rural contexts. The information included latrine knowledge and perceptions, access to water, water treatment and storage practices, characteristics of latrine and kitchen areas, current channels of communication, and status of existing latrine construction and service providers. The baseline survey complements data and information collected by the USAID-funded baseline surveys conducted by CRS and FXB within the scope of the Gikuriro activity.

Methods The survey used a cross-sectional study design consisting of a representative two-stage cluster sampling of households in the intervention areas of the Isuku Iwacu project.

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A total of 2,227 households were surveyed in the eight intervention areas of the Isuku Iwacu project. The sample household was selected using the probability proportional to the sample size (PPS) technique.

For the first stage, 111 villages were randomly selected for the survey in the eight selected districts within three provinces (South, West, East) and Kigali City. Since villages were randomly selected, this ensured a sample of communities with different characteristics (e.g., sanitation status, Ubudehe classification). For the second stage, interviews were conducted at the household level. One person per household, ideally the head of household, was interviewed. In addition, 27 key informant interviews and 15 FGDs with beneficiaries were conducted in selected communities as part of the qualitative portion of the survey.

3.1 Key findings

Socio-economic and demographic characteristics Of the 2,227 surveyed households, majority of households surveyed where in rural areas (78%), with only 22% from urban areas. Majority of households surveyed belong to Ubudehe Categories 2 and 3. Similar to the Gikuriro baseline survey, the baseline survey reported that with majority of latrine owners belonging to Ubudehe category 3 (54%) and majority of non-owners belonging to Ubudehe category 2 (43%).

Households tend to have male household heads (71% of latrine-owning households and 66% of non-latrine owning households). This trend is consistent with the findings from DHS 2015 (69% of households surveyed were headed by men) and the 2016 Gikuriro report (72% of households headed by men).

Majority of households had a family size of 1 to 5 members (67% for latrine-owning households and 74% of non-owning households). The most common family size is between 4 to 5 family members, which is consistent with the average 4.3 family size reported in DHS 2015. Larger families are more common for households in Ubudehe category 3, where 36% of latrine-owning households have families with 6 to 10 members and 28% of non-owners have families with 6 to 10 members.

Majority of surveyed households are in rural areas, which reflects the high proportion of Rwandans that live in rural areas. However, the proportion of rural households that own latrines decreases as wealth increases. While there are 72% of latrine owning households in rural areas, the proportion of rural households in Ubudehe category 1 is higher (85%) compared to wealthier categories (78% for Ubudehe category 2 households, 67% for Ubudehe category 3 households, and 45% for Ubudehe category 4 households). In contrast, although a higher proportion of non-owners are rural households, there is no decreasing trend that can be observed across Ubudehe categories.

In terms of house ownership, 4 out of 5 households own their own house, regardless of latrine ownership. Households in urban areas are more likely to rent their homes, compared to rural households (49% of urban households compared to 12% of rural households).

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Aside from Jericans, mobile phones and radios are the assets most commonly owned by households. The baseline survey results are consistent with the Gikuriro report and the DHS 2015: according to DHS 2015, 60% of households own mobile phones and 55% own a radio. Seventy-six percent of latrine owners and 51% of non-owners have mobile phones, and 62% of latrine owners and 36% of non-owners have radios.

Current access to water Out of 2,227 households surveyed, 1,164 (52%) households report using unimproved sources of water, and 236 (11%) households use surface water. Only 869 (39%) of households use improved sources of water. Improved sources of water are tap water, public standposts, boreholes and tubewells, protected wells and springs, rainwater, packaged water, and delivered water from tanker trucks or small carts, as defined by

JMP 2017.

Twenty-five percent of households have access to basic water service, meaning they use an improved water source and spend less than 30 minutes collecting water and returning. Meanwhile, 13% of households have access to limited water service, meaning they also use an improved water source but spend more than 30 minutes collecting water and returning. 1,164 households (52 %) use unimproved sources of water, 869 households (39%) use improved sources and 236 households (11%) use surface water.

In terms of water availability, 60% of households surveyed report always having water.

Poorer households spend more time collecting water compared to wealthier households. To illustrate, 80% of households in Ubudehe category 4 spend less than 30 minutes collecting water, compared to only 51% of households in Ubudehe category 1.

The average daily payment for water is RwF 124, with the most common amount paid by a household is RwF 100. Non-latrine owners pay less per day compared to latrine owners: on average, non-owners pay only 98 RwF per day compared to latrine owners who pay 138 RwF per day. Non-owners most commonly pay 100 RwF per day, which is a lower rate than latrine owners who most commonly pay 150 RwF per day.

In terms of water treatment practices, 58% of households treat their water, and the most common water treatment process is boiling (92% of households boil their water).

Fifty-seven percent of households in Ubudehe category 1 do not use any water treatment, compared to at least half of households in the rest of the Ubudehe categories.

Current access to improved sanitation Of the 2,227 surveyed households, 55% owned improved latrines while 45% did not own improved latrines. This result is consistent with the Gikuriro baseline report and viii

DHS 2015, which report that 52% and 54% of households use an improved, non-shared toilet/latrine facility, respectively.

The pit latrine with slab is the most common type of toilet, with 92% of rural households and 68% of urban households that report using this. There is limited access to automatic cistern flush toilets, with only households in Kicukiro (23%) and Nyarugenge (21%) reporting substantial use.

In terms of the materials used for latrines, 77% of households with improved latrines have a lined pit beneath the latrine. Latrines most commonly have a wooden slab (38%), have mud brick walls as enclosure (63%), and a door (49%). Only 13% of latrine owners have a latrine for bathing. As for the cleanliness of latrines, 20% of households with latrines had not latrine cover, leaving feces and urine exposed. Forty-eight percent of households cleaned the latrine once a day.

The presence of handwashing facilities is still low among households with improved latrines in general, with only 34% of households reported as having one. Urban households tend to have a higher proportion of households with handwashing facilities compared to rural households: 50% of urban households with latrines have handwashing facilities compared to 27% of rural households with latrines. Of households with handwashing facilities, majority had water and soap available (79%).

The most common type of soap available is bar soap (24%), followed by liquid soap (7%). The device used for handwashing varies: the most common is a wash basin (34%), followed by a tap (20%) and a tippy tap (13%).

The limited use of handwashing facilities reflects the state of progress of handwashing in Rwanda, as reported by JMP 2017. According to the DHS 2010, only 10% of households had a place for handwashing. Among households that had a hand washing facility, only 21% had water and soap for handwashing. Again, the same trend was reported in the Gikuriro study, which reported that 22.7% to 30.7% of respondents had a handwashing facility within five meters from the toilet.

Current access to unimproved sanitation Of the 2,227 households, 45% use unimproved facilities. Households that use pit latrines without slab account for 35% of households with unimproved latrine facilities.

Only households in Ubudehe categories 1, 2 and 3 use unimproved latrines. Wealthier households who belong to Ubudehe category 4 do not use unimproved latrines. Among households with unimproved latrines, 27% share the use of the latrines. The most common facility shared is pit latrine with slab (83%), followed by pit latrine without slab (13%). Households usually share latrines with one other household (41%), and smaller proportions of households share with two or three more households (25% of households and 16% of households, respectively). Majority of households (81%) know ix who they are sharing their toilet with, although 18% of households report not knowing who they were sharing their toilet with.

Defecation practices Majority of adults defecate in household latrines: 99% of latrine owners and 90% of non-owners. Open defecation is practiced more by non-owners, but only to a limited degree (2% of non-owners practice open defecation near the house). There is a higher proportion of households that report children openly defecating in areas near the house.

Defecation places are closer to latrine-owning households compared to non-owners.

Latrine owners only need to travel 5 meters on average to get to their defecation place, compared to non-owners who need to travel 7 meters on average. It is common for latrine-owning households to be only 1 meter away from their defecation place, while it is common for non-owning households to be farther from their defecation place that is 5 meters away.

Of the 1,043 households that have children less than 5 years of age, only 22% practice safe disposal of children’s feces. Unsafe disposal of children’s feces is still practiced among households with improved latrines, even though these households have access to improved latrines. A large proportion of households, latrine-owning and non-owners alike, dispose of children’s feces in outside premises or into waterways.

Satisfaction with current defecation place Fifty-three percent of male non-owners and 47% of female non-owners report being unsatisfied with their current defecation place, compared to 44% of male owners and 51% female owners who report satisfaction with their current defecation. The proportion of non-owners that report being very unsatisfied with their current defecation place (15% of men and 16% of women) is almost the same level as the proportion of owners who report being very satisfied with their current defecation practice (19% of men and 16% of women).

There is a larger proportion of dry type latrine owners that are unsatisfied with their current defecation place, compared to dissatisfied owners of pour flush type toilets (31% are unsatisfied with dry type toilet for defecation, compared to 6% that are dissatisfied with pour flush toilet for defecation).

Knowledge of latrine technologies and geographic locations to purchase materials Pit latrine with slab is the most commonly known latrine technology; 91% of latrine owners and 83% of non-owners report familiarity with it. On the other hand, there is very limited familiarity with basic latrine technology such as bucket toilets and hanging toilets, with only around 1% of households reporting familiarity with it.

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Wealthier households tend to be more familiar with advanced latrine technologies (e.g., automatic cistern flush), while poorer households tend to be more familiar with basic latrine technologies such as pit latrines. To illustrate, 79% of households in Ubudehe category 4 know automatic cistern flush toilets, while only 25% of Ubudehe category 1 households are familiar with this. On the other hand, households that are familiar with pit latrines with slab accounted for 82% of households in Ubudehe category 1, 89% of households in Ubudehe category 2, and 89% of households in Ubudehe category 3.

With regards to latrine construction, both latrine owners and non-owners reported that they would buy materials in the village, which suggests close proximity to available materials (28% of latrine owners and 37% non-owners). However, the second most common answer was “don’t know” which suggests the likelihood that households are uncertain of where latrine construction materials can be purchased (25% of latrine owners and 23% of non-owners).

Latrine perceptions and preferences The most common perceived advantages to latrine ownership are: (i) improved hygiene, health and cleanliness, (ii) increased privacy, (iii) convenience, (iv) increased safety, and (iv) availability for guests. The same set of advantages in the same rank, can be observed across non-owners and owners alike, Ubudehe categories, districts, and income levels.

With regards to perceived disadvantages, households that use dry type toilets most commonly cite bad smell as a disadvantage to owning latrines (41%). In comparison, the majority households that use flush or pour flush type of toilets report that there are no disadvantages to latrine ownership (52%). More households that own dry type toilets perceive cost as a disadvantage of latrine ownership: 30% perceive cost to build and 21% perceived cost to maintain as disadvantages. In contrast, households that use flush or pour flush type toilets more commonly cite other disadvantages unrelated to cost instead: bad smell (32%) and latrines attract flies (22%).

The most preferred features are related to the appearance and cleanliness of their preferred latrine. For owners and non-owners alike, the most common favorite feature of preferred latrine is that is looks good and comfortable, with 80% of owners and 79% of non-owners reporting this.

Non-owners expected to pay less for the latrines (median amounts ranged from RwF 40,000 to 50,000) compared to latrine owners (median amounts ranged from RwF 46,500 to 73,000).

Triggers for latrine adoption In all districts, construction of a new house triggers latrine construction in households.

The second most commonly cited trigger to build a latrine are reasons other than those specified in the survey. In some cases, a sanitation campaign also triggers households to build a latrine. Similarly, for households in Ubudehe categories 2 and 3, the most common trigger for latrine-owning households to construct a latrine is construction of xi a new house. Only a small proportion of households cited a sanitation campaign as a trigger to construct a latrine.

Latrine construction among latrine owners Households were also surveyed on latrine construction, from the decision making process to the time and process involved in completing construction. For majority of households, regardless of Ubudehe category or district, the head of household makes the final decision about buying a latrine.

Forty-two percent of respondents state that it takes less than two weeks to build a latrine, while 26% of respondents state that it takes 3 to 4 weeks to build a latrine.

When comparing households that have different types of latrine, a larger percentage of households that use dry toilets say that it takes less than two weeks to build a latrine (45%) compared to households that use flush/pour flush toilets (19%). Among households that use flush/pour flush toilets, majority of households (38%) do not know how long it takes to build a latrine.

Seventy percent of households hired a person from the village, while 26% hired from outside the village. The most common reason for hiring the person was because of good reputation (63%), followed by inexpensive cost to hiring the person (19%), and because the person was a relative or friend (12%). The hired person was most commonly someone who was recommended by someone else in the village (33.9%) or a relative or friend (22%). One of five households stated other reasons such as they knew the hired person because he was a neighbor, someone who shared the same religion (barasengana), or because the person was looking for work.

The person who purchased materials for latrine construction was most commonly the hired person (53%), so there must be a high level of trust. Twenty-eight percent of households cited that they themselves bought the materials for building the latrine.

The most common previous improvements were for constructing coverings for the latrine, such as improving the slab, roof, and walls. At the Ubudehe category level, the most common improvement was improved slab (19%) for households in Ubudehe category 1, improved walls and roof (18% each) for households in Ubudehe category 2, and improved roof (18% for households in Ubudehe category 3.

The most common planned improvement for Ubudehe categories 1, 2, and 3 are improving the walls, roof, slab, pan, and building a door. Each Ubudehe category prioritized different latrine improvements. For example, the most commonly reported latrine improvement for households in Ubudehe category 1 is building a door (45%), followed by improving the walls (40%). On the other hand, households in Ubudehe categories 2 and 3 had larger proportions of households reporting more planned latrine improvements such as improved walls, roof, slab, and building a door.

Intended latrine construction among non-owners Fifty-six of non-owners have thought about or discussed buying a latrine. Of these households, 49% are in Ubudehe category 2 and 31% are in Ubudehe category 1. The last time this discussion occurred was 1to 6 months ago or 7 to 12 months ago. For xii majority of households in Ubudehe category 3 (36%), building a latrine was discussed less than a month ago. Based on the responses from FGDs, poverty is usually considered as a barrier to owning a latrine.

Two-thirds of households say that there is at least a medium likelihood that they will build a latrine within a year: 42% of households report medium likelihood of latrine construction, while 24% of households report high likelihood. There are still 22% of households who say that there is no chance that they will build a latrine within a year.

The amount that these households are willing to spend for latrine construction is usual within the range of RwF 10,000 to 40,000 for most households in Ubudehe categories 1 and 2 (50% and 49% of households, respectively), while wealthier households in Ubudehe category 3 are willing to spend more (46% of households), from RwF 40,000 to 80,000.

Majority of households consider getting a mason: 35% of households have identified a mason to hire, and 23% have not yet identified a mason to hire. Only 27% of households will build the latrine on their own without the assistance of a mason. Of those requiring a mason, majority of households hire a mason from the village (54%), while a sizeable percentage (41%) hire from outside the village. The most common reason for hiring a mason is because the mason has a good reputation (at least half of households across all Ubudehe categories agree with this), followed by quality of work (33% of households saw and liked a latrine the mason had built).

When buying materials, majority of households (35%) would buy latrine materials in the village, while 23% would buy materials in the sector. Twenty-seven percent of households do not know where to buy materials for latrine constructions.

Latrine emptying practices Households that use water for flushing are mostly in Ubudehe categories 3 where 76% and 85% of households report flushing with water, respectively. There are no households in Ubudehe Category 1 that use water to flush their toilet.

With regards to the amount of water used for flushing per day, households in Ubudehe categories 3 and 4 typically use 6 to 15 liters a day (40% of households and 47% of households, respectively). Majority of households in Ubudehe category 2 use 16 to 25 liters per day. Since larger family sizes (i.e. 6 to 10 members) are more common in Ubudehe categories 2 and 3, the larger household size may be driving high water usage.

In general, only 7% of latrine owners emptied their pit at the time of the survey. Of these, 50% of households that emptied pits belonged in Ubudehe category 2, followed by households in Ubudehe category 3 (36%). In terms of hiring a person or a service to empty the latrine pit, only 18% of households reported hiring someone else for this.

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Of those that hired assistance to empty their pit, majority of these households were those in Ubudehe category 3 (53%), followed by Ubudehe category 2 households (35%). Hence, among Ubudehe categories, households in Ubudehe category 2 and 3 are more likely to hire someone for pit emptying.

Households usually emptied their pit right away once it became full (65% of households, ranging from 61% to 69% across Ubudehe categories 1, 2, and 3).

However, there is still 5% of households that wait more than 12 months before emptying the pit. Latrine contents are most commonly sealed before a new pit is dug (72%).

Current hygiene practices When comparing latrine owners with non-owners, a higher proportion of latrine owners wash their hands with soap more than three times per day (65% of latrine owners compared to 48% of non-owners). The most commonly stated reasons for handwashing are health-related. Majority of households washed their hands to remove dirt or clean their hands (95% of latrine owners and 90% of non-owners). The second most common reason for handwashing is to prevent disease (50% of latrine owners and 44% of non-owners), followed by removing microbes or bacteria. Households most commonly wash their hands before eating (77% of latrine owners and 69% of non-owners). The second most common time for handwashing is when people think they are dirty (76% of latrine owners and 68% of non-owners).

Among all households, 73% have a kitchen or cooking area designated for preparing or storing food. A higher proportion of latrine owners have a kitchen or designated cooking area compared to non-owners (79% of households compared to 66% of households). A higher proportion of latrine owners have a kitchen drying rack compared to only 33% of non-owners. A higher proportion of latrine owners clean their kitchen or cooking area everyday (76%) compared to only 60% of non-owners. Water is the most common way that households clean their kitchens (31% of latrine owners and 30% of non-owners). Twenty-seven percent of households use water and soap together, and a higher proportion of latrine owners practice this (30%) compared to non-owner (20%). For households that use cleaning products, the most common is bar soap (88%), followed by liquid soap (8%) and detergent (3%). Bar soap is more commonly used by non-owners (98%), while liquid soap is more commonly used by latrine owners (10%).

The most common source of hygiene information for both latrine owners and non-owner is through community meetings (70% and 69%, respectively). The next most common source of information is the CHC member (51% of latrine owners and non-owners, alike), followed by the Village Chief (47%% of latrine owners and 43% of non-owners). In terms of communication devices, radio is the most commonly cited source of information through a device, with 36% of latrine owners and 21% of non-owners reporting this as a source of hygiene information.

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In terms on the type of hygiene advice received, households commonly received advice on using a latrine, drinking safe water, handwashing, and good food hygiene.

There is a low proportion of households that received advice on how to manage wastewater and stagnant water (20% of latrine owners and 19% of non-owners) and safe disposal of babies’ feces (16% of latrine owners and 15% of non-owners).

Communication channels currently used The most common sources of information are key members of the community, such as CHC members, neighbors, and CHWs. Majority of households get their information from CHC members (64% of latrine owners and 66% of non-owners). In terms of communication devices, there are more households that use radio as a communication than television.

When it comes to latrine construction and purchasing sanitation and hygiene services and products, the most reliable source of information is a government officer, followed by NGO and CSO workers. Households are wary about information from a shop or a seller, with 38% of households ranking it as an acceptable source and 29% of households saying that it is not a good source of information.

Saving and lending practices A larger proportion of latrine owners belong to a community group compared to non-owners (53% of latrine owners compared to 46% of non-owners). Of those that belong in a community group, usually only one member of the household is involved (36% of latrine owners and 36% of non-owners report this). Households that belong to a community group most commonly belong to a VSLA (34% of latrine owners and 37% of non-owners), followed by Tontines (22% of latrine owners and 23% of non-owners).

Hence, the most common locations for households to put their savings is in VSLA, followed by Tontine. The same proportion of men and women belong to a saving group (49%). There is no association between saving group membership and the gender of the respondent (p=0.8 > 5%), so each gender is equally likely to belong to a saving group.

July is the month when both latrine owners and non-owners receive the highest income. On the other hand, April and November are two months where households receive the lowest income. Compared to other Ubudehe categories, majority of Ubudehe category 4, report that they receive the same income every month (74%).

There is a larger proportion of latrine-owning households who save compared to non-owners. Sixty-three percent of latrine-owning households save, compared to 46% of non-owners. Similarly, bank account ownership is also higher among latrine-owning households, where 56% of households report to having a bank account compared to only 33% of non-owners. For households who save, it is most common to put aside money each week, as reported by 24% of non-owners and 22% of latrine owners. A higher proportion of latrine-owning households put away money each month (21%), compared to non-owners (10%).

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Bank account ownership also increases as household wealth increases: only 37% of households in Ubudehe category 1 have a bank account compared to 39% of households in category 2, 55% of households in category 3, and 84% of households in category 4.

In terms of borrowing money, a higher proportion of latrine-owning households had loans compared to non-owners (26% of latrine-owning households compared to 16% of non-owners). Non-owners loans are usually small: 40% took out loans less than RwF 100,000 and 32% took out loans ranging from RwF 100,000 to RwF 500,000.

Loan amounts of latrine-owning households are more varied: 33% are loans ranging from RwF 100,000 to RwF 500,000, 27% are less than RwF 100,000, and 27% are above one million RwF. Owners usually took loans for building a house, buying equipment, or business. There were no reported loans taken out for latrine construction.

Current gender practices Majority of household decisions are still made by men, given that majority of household heads are male and the final decision maker (at least when it comes to latrine construction) is the household male. This is consistent with the Gikuriro gender analysis, which states that women are rarely engaged in household decision making in terms of water and hygiene. To illustrate, for majority of households, regardless of Ubudehe category or district, the head of household makes the final decision about buying a latrine. According to the survey, 71% of latrine-owning households have male household heads, while it is 66% for non-owners.

On the other hand, men and women are equally likely to participate in saving groups, with 49% of male and female respondents reporting membership to a saving group.

3.2 Conclusion and Recommendations

The main barrier to wider access to improved sanitation facilities is a lack of means and resources to build and maintain improved latrines, adequate hand washing facilities, and clean water use. Households generally understand the importance of using improved latrines and observing good hygiene practices, but lack of funds, access to better tools, and low awareness about the link of good hygiene to health and latrine technology prevent them from doing so.

Key findings Recommendation Socio-economic and Demographic Characteristics of the Households Among the Ubudehe categories, households in Ubudehe category 1 are disadvantaged when it comes to access to improved sanitation and water sources, financial products and

Target Ubudehe category 1 households to improved their access to resources, provide assistance, and increase awareness of health benefits of advanced latrine technology.

xvi services, and awareness of more advanced latrine technology.

54% of household heads are female for households in Ubudehe category 1.

Tailor interventions that appeal more to female household heads, and integrate empowerment for female in training materials.

Male household head tends to make most of the decisions for the household

Trainings can include modules on empowering women or the spouse. This promotes gender equality when making household decision and resource allocation.

Cost is a major barrier to latrine construction House construction is the most common trigger for latrine construction

Provide guidance on proper construction of improved latrines for households.

Explore possibility of providing information for households to upgrade their latrine type when constructing a new toilet.

Latrine construction is not a priority for household spending

Emphasize the linkage between access to improved latrines and good health.

Explore possible financing facilities or resource-sharing schemes that can increase the affordability of latrine construction, or allow households to easily upgrade existing facilities (i.e.

adding doors, wall, roof or slab to the latrine).

Low access to specialty tools for hard rock

Promote latrine prototypes and access to financing or to resource-sharing schemes that can address some household’s need for specialty tools for digging pits in hard soil and rock.

Most latrine households plan to improve their latrines by improving the walls, roof, slab, pan and building a door.

Explore possibility of offering small value sanitation loans so that households can add enhancements that improve cleanliness or increase privacy, such as slabs for uncovered pit latrines, doors, roof, or walls.

xvii

Low saving group membership, especially among Urban households and households in Ubudehe category 1

Explore ways to increase saving group membership in areas that report low saving group membership: Urban households, and Ubudehe category 1 households. In terms of districts, overall there is opportunity to promote saving group membership in all districts

Create champions for trusted sources of information High ownership of radio and mobile phones.

Use radio and mobile phone devices as tools for information dissemination

Community leaders are trusted sources of information.

Train CHC members, Village Chiefs, CHWs, Government employees, and CSOs/NGO workers on effective ways to disseminate information on improved sanitation and proper hygiene.

For those who are members of savings group, membership is most popular in VSLAs and Tontines

Explore possibility to promote saving for latrine construction or sanitation facilities (i.e., handwashing places) among members of VSLAs and Tontines.

Equate the idea of proper hygiene practices with good health Low proportion of households that treat water.

Increase awareness on water treatment methods upon collection and before use. This is beneficial for households that rely on unimproved water sources, as well as to decrease the risk of contamination during storage.

Lack of handwashing facilities and limited use of soap.

Promote frequent handwashing as a way to combat diseases, to spur more frequent use of handwashing facilities, improved maintenance of handwashing facilities, and construction of handwashing facilities near toilet or kitchen.

The proportion of households that report washing their hands during the following critical periods increases as household wealth increases, especially among latrine owners: when hands are dirty, before eating, and after defecation or urination.

Target the promotion of handwashing after using the latrine to households in Ubudehe category 1. In fact, interventions should also promote handwashing after cleaning a child that has defecated or after changing a child’s nappy, since only 3% to 4% of xviii households wash their hands after being exposed to a child’s feces and urine.

Open defecation more prevalent among children.

Promote proper methods for children’s feces disposal. Decrease risk of contamination by promoting handwashing after cleaning children’s feces or urine.

Infrequent pit latrine emptying

Promote more frequent emptying of pit latrines to promote cleanliness and reduce risk of contamination of stored feces and urine. Increase awareness on the link of frequent emptying of pit latrines to good health and hygiene.

Explore possibility of ways to increase availability of people to hire for pit emptying, since hiring is already common for households in Ubudehe categories 2 and 3.

Increase availability of latrine construction materials and services locally Households prefer to purchase latrine construction materials in their village or sector.

Provide initiatives to encourage suppliers of latrine construction materials and services to build and expand businesses within the village or sector.

Masons are hired due to good reputation and referrals

Explore ways to create a more formal network of good masons that can easily be contacted for latrine construction.

This provides access to quality service for those seeking masons for latrine construction, and may be able to help promote latrine construction because of increased availability of latrine construction service providers.

Rwanda Sanitation Context

4.1 Overall Sanitation Context

Access to sanitation facilities and the promotion of good hygiene are significant challenges in Rwanda. Only around half of the population have access to an improved, unshared toilet facility, three out of four use an improved source of drinking water, close to half of households spend 30 minutes or more collecting water, and one in ten households have a place for handwashing. This is still behind the level of access of the global population on average, and for the Sub-Saharan Africa region, as reported by JMP 2015: 89% of the global population have at least basic drinking water service (improved source of drinking water that required no more than 30 minutes per trip to collect water) in 2015, and 58% of the Sub-Saharan population have at least basic drinking water service in 2015. In terms of access to basic sanitation services (improved sanitation facility not shared with other households), 68% of the global population used at least basic sanitation services in 2015, and only 28% of the population in Sub-Saharan Africa used at least basic sanitation services (18% of the SSA population had limited sanitation services, which is classified as such when it is improved facilities that are shared with other households). In terms of handwashing facilities at home, access varies widely among countries. JMP reports that in 2015, basic handwashing facilities with soap and water in 2015 was only accessible to 50% of the population in African countries with data.

In the context of Rwanda, it’s important to consider the distinction between urban and rural households. Eighty-four percent of the population resides in rural areas, and of those living in urban areas, 49% live in Kigali. Hence, notable differences between rural and urban households lead to richer insight when describing current sanitation access and hygiene practices in Rwanda.

Moreover, considering the link between good sanitation and hygiene practices and lower incidence of diarrhea, providing improving access to sanitation facilities and promoting good hygiene practices may pose significant gains in improving the overall health of Rwandan people.

According to the 2014-15 Demographic Health Survey (DHS 2015), 54% of households have access to an improved, unshared toilet facility. Among households with access to improved toilet facilities, the most common type is unshared pit latrine with slab (48% of households). There is still limited use and access to private and connected toilets, with only 1% of households have toilets that flush to a piped sewer system. There is opportunity to improve sanitation access by increasing access to resources that promotes private latrine ownership, especially for 17% of households that use a facility that would have been considered improved except for the fact that it is shared with other households.

DHS 2015 reports that rural households are more likely to use non-shared pit latrine with slab compared to urban households (51.9% of rural households, compared to 29.7% of urban households). On the other hand, urban households are more likely to use a shared pit latrine with slab (38.5% of urban households, compared to 10.6% of rural households). Of the 1% of households that use toilets that flush to a piped sewer, a larger percentage of urban households have access to this compared to rural households (5.7% of urban households compared to 0.2% of rural households.

According to DHS 2015, 73% of households use an improved source of drinking water such as protected springs (32% of households), public taps and standpipes (27% of households), and running water from their dwelling, yard, or plot (10% of households).

Majority of households do not treat water prior to drinking, and for households who use appropriate treatment the most common method is boiling (38%).

Rural households are less likely to use improved drinking water (31% of rural households use unsafe drinking water, compared to 9% of urban households), according to DHS 2015 estimates. Of these rural households that use unsafe drinking water, it is most common to collect water from an unprotected spring (16% of rural households), followed by collecting from surface water (13%) and retrieving water from a well (2%).

The effort required to collect water and return to the household also plays a role in water access and allocation of household resources. The time it takes for households in Rwanda to collect water and return varies greatly. Based on the DHS 2015 data, 49% percent of households spend 30 minutes or longer to collect water and return, while 41% spend fewer than 30 minutes. Only around one in ten households (11% of households) have access to water on their premises.

A larger percentage of rural households spend more time collecting drinking water compared to urban households. According to DHS 2015, 55% percent of rural households take 30 minutes or more to get drinking water, compared to only 19% of urban households. Yet, there are almost the same proportion of rural and urban households that spend less than 30 minutes to collect drinking water (41% of rural households and 38% of urban households).

Based on the 2015 DHS data, only 11.5% of households had a place for handwashing, and yet even these households had limited access to water or soap. Among households with handwashing facilities, 30.7% had no water, no soap, and no other cleansing agent, while only 37.4% of households had soap and water.

The 2015 DHS reports that rural households were less likely to have a place for handwashing (9.8% of rural households compared to 19.5% of urban households), and less likely to have soap and water in the handwashing facility (25.1% of rural households compared to 66.9% of urban households) or no water or any type of cleansing agent at all (38.5% of rural households compared to 11.9% of urban households).

Although sanitation and hygiene have been improving in Rwanda, additional efforts need to be made. The Government’s 2016 National Sanitation Policy aims to raise and sustain improved household sanitation coverage to 100% by 2018, and to promote hygiene behavior change. The baseline figures from 2015 report that 72% of households have improved sanitation facilities and 12% of households have a handwashing facility with water and soap at home. The NSP identified yearly targets that project a gradual increase of households with improved sanitation and handwashing facilities until 2030. The NSP aims to create an enabling environment where there is individual (household level) demand for sanitation services and a market with available and affordable sanitation products. The NSP identifies raising awareness for improved sanitation facilities and good hygiene practices as key to generating household level demand for sanitation services.

In terms of the sustainability potential of the sanitation efforts, the NSP acknowledges a possible “natural erosion” of commitment and investment into the operation and maintenance of sanitation facilities. According to the NSP, proper enforcement may mitigate the gradual decline of acquiring and using latrines over time, but suggests that adherence to social norm can serve as reinforcement for households. This supports the idea of behavior change, which starts with raising awareness for the benefits of sanitation facilities and proper hygiene practices, as a strategic tool in generating household demand for sanitation facilities and products.

4.2 Sanitation context in targeted districts

4.2.1 Kigali City

a. Nyarugenge

Majority of households in Nyarugenge district use improved source of water (90.4% of households in the district, compared to 8.3% of households that use unimproved water source).