INVESTIGATION OF SANITATION AND HYGIENE PRACTICES IN SELECTED RURAL AREAS OF THE NORTHERN PROVINCE, SOUTH AFRICA. ABSTRACT

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1 Presented at the WISA 2000 Biennial Conference, Sun City, South Africa, 28 May - 1 June 2000 INVESTIGATION OF SANITATION AND HYGIENE PRACTICES IN SELECTED RURAL AREAS OF THE NORTHERN PROVINCE, SOUTH AFRICA. LK Chauke*, MA Mathekgana* and FAO Otieno** *Department of Agriculture Conservation and Environment, P.O. Box 24, Rustenburg 0300, Tel , Fax ** Engineering Progamme, Technikon Southern Africa, PB X06, Florida 1710, Tel , Fax , fotieno@tsamail.trsa.ac.za ABSTRACT The main objective of this study was to identify local environmental conditions, practices and household defensive behaviour and routes of water-related diseases, while the primary purpose was to find out how to achieve an effective sustainable improvement of the community environment mainly by increasing awareness in hygiene, environmental health and sanitation to the rural communities. This was aimed at identifying the existing gaps in water supply and sanitation sector in the Northern Province, South Africa. To accomplish the objectives of the research, questions were asked in the form of questionnaires and personal interviews to schools, households and different government departments. The research findings indicate the following shortfalls poor household socio-economic status, water scarcity with 14% relying on rivers and 12.1% using unprotected wells without handpumps while no house connections were found. Hygiene practices were found to be bad in terms of water collection and storage. Sanitation facilities and practices were also poor with 88.3% of the population still relying on unimproved pit latrines and children less than 5 years defaecating outside the latrines, whilst 10.7% of the population still use the bush. Poor waste management was also found to be a recurring problem. Although the perception for this problem exists, households generally accept living with these different conditions. Generally, a lack of adequate knowledge on most of the factors that could pose risks to health was also identified. Long-term benefits will only come about, however if people change their water-use and hygiene related habits. To maintain reasonable health standards within rapidly growing population, governmental and non-governmental organisations must undertake more activities in this area.

2 2 INTRODUCTION: Rural water supply and sanitation present more difficult organisational problems than do urban services, partly because of past neglect. It is not usually possible for the rural undertaking to be fully self-sufficient financially, especially in the early years. Nearly one-fifth of rural dwellings have no toilet at all (McNamara, 1980). The disparity is again very conspicuous among the different population groups more especially in South Africa. Northern Province represents one of the provinces in the country, South Africa, with a large number of rural areas and the worst cases of provision of water supply and sanitation and generally a poor record of environmental health and hygiene practices (CSS, 1995; NSTT, 1995). Increasing awareness in hygiene, environmental health and sanitation amongst the rural communities can improve the situation in this sector. There has been a history of disregard for the views of communities in the field of sanitation provision. Service provision for low-income communities has been dominated by the public sector who have followed a top-down approach, with bureaucrats and consulting engineers making decisions with little involvement of communities. The communities have never had any sense of ownership for this systems and therefore leading to people not willing to pay for their services and often abusing them through frustration and partly through lack of understanding of how to use them (Palmer I., 1993, p ). Planners must find ways to bring project technology into balance with community resources, knowledge, attitudes and behaviours relating to health and sanitation. They must acknowledge that a technology that functions appropriately in one context may be impossible to transfer to another. Without this community understanding, the imposition of any new technology is a risky venture: the facilities will likely not be properly used and maintained and the health benefits will be forfeited. FIELDWORK: Northern Province has got a lot of rural areas and a mixture of the different levels of water supply provision and sanitation. This province represents the provinces in the country with the worst cases of provision of water and sanitation and has generally a poor record of environmental health and hygiene practices as a result of deficiencies in water and sanitation services. A survey was conducted in the Northern Province to establish the sanitation and hygiene practices available in villages of the respective regions. This study was conducted in three regions: Southern, Western and Central Regions. The criteria that was used to select these areas is as follows: current status of water supply and sanitation, location, whether the areas were accessible enough for the research team in terms of money and transport, vernacular languages being an advantage so as to cover all communities within the chosen regions.

3 STUDY DESIGN, POPULATION AND DATA COLLECTION: 3 The study sample consisted of government departments (only provincial departments): Health, Education, Environmental Affairs and Water Affairs and Forestry; Schools (primary and secondary) and Communities (households). Two different types of questionnaires were prepared, i.e. for households and schools. Different government departments were also visited in order to seek the relevant information in the form of interviews. The household questionnaire consisted of the following: demographic issues, water and sanitation, environmental and family health, socio-economic factors and also hygienic practices; whereas the school questionnaires consisted of water supply, sanitation and hygiene. A total number of 193 households and 30 schools were surveyed. Since the conditions in all the regions were the same, the total sample was treated as one entity. The data from the survey was then analysed by SPSS for Windows. RESULTS AND ANALYSIS: Spreading the word about what people should do to be healthy is important, but this might not be enough. We have to understand that, in many situations, it is not only the individual who need to change, there are other things that influence the way people behave: the place in which they live, the people around them, the work they do, whether they are able to earn enough money or not - all these have a great influence, and they must be taken into consideration (WHO, 1993, pp. 1-24). 1. Socio-economic issues: Table 1.1: Percentage distribution of household heads s income per month Income of the household head/month (R) Percentage distribution (%) R100 - R1 000 R R2 000 R R5 000 R R R plus It was found that from 89% of the households, only one person contributed towards the demands of the family and for a big family of about 8 people or more, a lower salary hinder the dependants to live a healthy standardised life. People usually fail to follow proper sanitation and hygiene practices due to the lack of money, which has to cover all their basic needs such as water, food, education, health and all the basics of life. The choice of facilities in terms of water supply and sanitation is also affected by the lack of money which usually lead to people choosing unimproved facilities like pit latrines and rivers (for water supply), which might prove to be very detrimental to their health. These are preferred because they do not require any maintenance and therefore no money will be spent.

4 Table 1. 2: Percentage distribution of the education of the household heads 4 Education Percentage distribution (%) No formal education Primary education Secondary education Tertiary education From the education background of the household heads, it is clear that 55.8% have got little knowledge or no knowledge at all more especially concerning water supply and sanitation. During the survey, mostly women were well informed on health matters, hygiene and sanitation practices. The reason was that most women were taught these things at the clinics during their pregnancy. Men were uninformed to the extent that when filling questionnaires they occasionally mentioned diseases that were far from hygiene and sanitation related. Table 1.3: Percentage distribution of the households size in terms of rooms Households size (rooms) Percentage distribution of the households (%) The survey has shown that 39% of the households have 12 members as the largest size and a predominating number being 8 members at 47%. This has shown that it is impossible for 8 people sharing a 1-4 roomed house to practice proper hygiene. 2. Water Supply and the Environment issues: The following are the results that were found from the household survey:

5 Table 2.1 Percentage distribution of water supply sources: 5 Water supply sources House connections Plot connections Communal taps Well without handpumps Private borehole River Percentage distribution households % of the households were found to be using communal taps which are not reliable because they can go up to 36 weeks without functioning and during this time the poor communities will have to resort to other unsafe sources of water supply. This scarcity of water can also lead to people not observing proper hygiene practices. The wells that are used are very deep and can pose a lot of danger when water is collected as 94.4% of the water collectors in these communities are women and children. The communities often have to walk the distance of 1 to 2 kilometres which takes them about an hour to two before they can collect water. The water is collected 2 or three times a day depending on the needs, availability and the reliability of the source. The survey also indicated that 67.3% of the households, collect 200 litres of water which must last the whole week for an average family size of eight, which therefore means that each person is entitled to 25 litres per week. Water scarcity had prohibited people from complying with the standards (to perform both personal and household hygiene) as stated by (Broome, J., 1990, pp. 4) that a water consumption of 30 to 50 litres/person/day is often regarded as the minimum for the healthy and disease-free life. The schools situation is not very different from that of the households with children and teachers having to walk about 500 metres to the water source. Only 28.9% of the schools were found to have hand-washing facilities next to the latrines. This situation does not in any way encourage acceptable hygiene practices like hand washing after using the latrine. 3. Sanitation: 88.3% of the households that were surveyed still used unimproved pit latrines and 10.7% were without latrines at all (they either used the bush or the neighbour s latrine). The schools also experienced the very same situation with 100% of them relying on unimproved pit latrines. These toilets have got a lot of problems ranging from flooding during rainy seasons, flies and mosquitoes which usually lead to dangerous diseases like malaria, diarrhoea and many other intestinal diseases.

6 CONCLUSIONS: 6 The survey showed that the socio-economic status of the area under study is poor because the household heads were illiterate (lack of adequate knowledge on water supply, health and sanitation), have low-income earnings and poor employment that leads them to choose the unimproved pit latrines, poor water supply sources and poor housing that is not proportional to the household members numbers in terms of performing proper hygiene practices. The assessment on both hygiene and sanitation indicates that the problems are water scarcity, poor waste management, the use of polluted water (river and unprotected wells without handpumps), the use of poor sanitation facilities and low literacy in terms of water supply and sanitation. People seemed to be unaware of some of their practices as the transmission route for diseases. The research provides the basis for more qualitative questions, to provide a more in-depth understanding on perceptions and practices in the population. In other words this might lead to more in depth knowledge on the chain of relations between what the households may or may not identify as being an environmental problem due to its poor practice, what they detect as the source and cause of the problems, and what directs their attitudes towards possible solutions. RECOMMENDATIONS: To maintain reasonable health standards within rapidly growing areas, governmental and nongovernmental organisations must undertake more activities in this area. There is also an acute need at all levels of authority to become more aware and sensitive to problem of the environment. Hygiene education should be seen as an important aspect within the environment and it should be re-designed to contain specific messages targeted for particular audiences with the follow up to see whether or not the messages are received correctly and acted upon. REFERENCES: 1. Broome J. and McGarry M., (1986), Sanitation Technology Selection - Information and Training for Low-Cost Water Supply and Sanitation, International Bank for Reconstruction and Development/The World Bank, Washington D.C., USA, pp Central Statistical Services (CSS), 1995, Northern Province Statistics - Part 9, CSS Report No (1995), Pretoria, RSA, pp McNamara R.S., (1980), Water Supply and Waste Disposal (Poverty and Basic needs Series), World Bank, USA. 4. National Sanitation Task Team (NSTT), 1995, National Sanitation Policy - Draft of White Paper on Sanitation, DWAF, Pretoria, RSA, pp Palmer I., (1993), Strategies for improving the provision of sanitation to poor people in South Africa s urban areas, Palmer Development Group, University of Cape Town, Water Research Group, RSA, pp World Health Organisation, (1993), Education for health - A manual on health education in primary health care, Geneva, pp