Nòt sou twalèt ak ijyèn: Pèspektiv nan men Fwaye ak Biznis nan Pòtoprens ak Kafou

Notes on Toilets and Hygiene: Perspectives from Households and Businesses in Port-au-Prince and Carrefour Optimal Sanitation Jason Cardosi Sergio Perez Edition: Anamaría Núñez IDB-TN-1239 Water and Sanitation Division TECHNICAL NOTE Nº January 2017 Notes on Toilets and Hygiene: Perspectives from Households and Businesses in Port-au-Prince and Carrefour Optimal Sanitation Jason Cardosi Sergio Perez Edition: Anamaría Núñez January 2017 Cataloging-in-Publication data provided by the Inter-American Development Bank Felipe Herrera Library Cardosi, Jason. Notes on toilets and hygiene: perspectives from households and business in Port-au- Prince and Carrefour / Jason Cardosi, Sergio Perez. p. cm. — (IDB Technical Note ; 1239) Includes bibliographic references. 1. Toilets-Haiti. 2. Sanitation-Haiti. 3. Hygiene-Haiti. I. Perez, Sergio. II. Inter- American Development Bank. Water and Sanitation Division. III. Title. IV. Series. IDB-TN-1239 JEL code: Q25 Q28 Q20 Q54 Q44 O18 O19 Keywords: Water, Sanitation, Sanitation Products, Behavioral Change, Perceptions, Haiti. We thank the support of three students from Quisqueya University throughout the process of the household surveys: Jeff Schleiden COLO, Carmelle Yoldine CADET and Rose Andrée ALTEMA. Copyright © Inter-American Development Bank. This work is licensed under a Creative Commons IGO 3.0 Attribution- NonCommercial-NoDerivatives (CC-IGO BY-NC-ND 3.0 IGO) license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/ legalcode) and may be reproduced with attribution to the IDB and for any non-commercial purpose. No derivative work is allowed. Any dispute related to the use of the works of the IDB that cannot be settled amicably shall be submitted to arbitration pursuant to the UNCITRAL rules. The use of the IDB's name for any purpose other than for attribution, and the use of IDB's logo shall be subject to a separate written license agreement between the IDB and the user and is not authorized as part of this CC-IGO license. Note that link provided above includes additional terms and conditions of the license. The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent. http://www.iadb.org 2017 1 NOTES ON TOILES AND HYGIENE PERSPECTIVES FROM HOUSEHOLDS AND BUSINESSES IN PORT-AU-PRINCE AND CARREFOUR OPTIMAL SANITATION NOTES ON TOILETS AND HYGIENE NOTES ON TOILES AND HYGIENE www.iadb.org Copyright © 2017 Inter-American Development Bank. This work is licensed under a Creative Commons IGO 3.0 At - tribution-NonCommercial-NoDerivatives (CC-IGO BY-NC- ND 3.0 IGO) license (http://creativecommons.org/licen - ses/by-nc-nd/3.0/igo/legalcode) and may be reproduced with attribution to the IDB and for any non-commercial purpose. No derivative work is allowed. Any dispute related to the use of the works of the IDB that cannot be settled amicably shall be submitted to arbitra - tion pursuant to the UNCITRAL rules. The use of the IDB’s name for any purpose other than for attribution, and the use of IDB’s logo shall be subject to a separate written li - cense agreement between the IDB and the user and is not authorized as part of this CC-IGO license. Note that link provided above includes additional terms and conditions of the license. The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent. Edition: Anamaría Núñez Graphic Design: www.souvenirme.com Cataloging-in-Publication data provided by the Inter-American Development Bank Felipe Herrera Library Cardosi, Jason. Notes on toilets and hygiene: perspectives from hou - seholds and business in Port-au-Prince and Carrefour / Jason Cardosi, Sergio Perez. p. cm. — (IDB Technical Note ; 1239) Includes bibliographic references. 1. Toilets-Haiti. 2. Sanitation-Haiti. 3. Hygiene-Haiti. I. Pe - rez, Sergio. II. Inter-American Development Bank. Water and Sanitation Division. III. Title. IV. Series. IDB-TN-1239 JEL code: Q25 Q28 Q20 Q54 Q44 O18 O19 Keywords: Water, Sanitation, Sanitation Products, Beha - vioral Change, Perceptions, Haiti. We thank the support of three students from Quisqueya University throughtout the process of the household surveys: Jeff Schleiden COLO, Carmelle Yoldine CADET and Rose Andrée ALTEMA 2 BY JASON CARDOSI AND SERGIO PEREZ JANUARY, 2017 NOTES ON TOILETS AND HYGIENE PERSPECTIVES FROM HOUSEHOLDS AND BUSINESSES IN PORT-AU-PRINCE AND CARREFOUR OPTIMAL SANITATION 4 NOTES ON TOILES AND HYGIENE TABLE OF CONTENTS Executive Summary Introduction Methods Findings A. Perceptions and behaviors around sanitation products B. Pricing C. Distribution (retailing) D. Services E. Promotion Conclusions Annex - Questionnaires References 5 6 8 9 9 12 12 13 14 15 18 23 5 NOTES ON TOILES AND HYGIENE EXECUTIVE SUMMARY In support of The National Directorate of Water and Sanitation in Haiti’s aims to integrate WSS promotion with improvements in infrastructure and product availability, this note offers some household and business views the availability and perception of sanitation products (goods and services), as well as some constraints and drivers related to accessing and utilizing them. This note is a supplement to the Résultats du prélève - ment des données de l’eau potable et l’assainisse - ment dans l’aire métropolitaine des communes Carrefour et Port-au-Prince, Haïti (2016) and the result of semi-structed interviews carried out in the same study area among low income residents. When asked to share views on their sanitation facil - ities, residents using pit-latrines or no facility offe- red no positive attributes, unlike users of pour flush toilets that led to a pit. When describing their pit latrines, users stated dislikes such as smell, lack of comfort and presence of bugs. Flush toilet users citied likes such as lack-of-odor, ease of clean - ing, and comfort. Residents without a facility or with an unusable one cited embarrassment and inconvenience as key dislikes. All the respondents stated they washed their hands with water, and soap or soapy water after using a latrine or toilet. However, like the larger survey, there was little evidence of handwashing with soap and only one household had a place set up to wash hands. All the residents interviewed would prefer to have a seated flush toilet with comfort gave as the main reason. They indicated cost and ownership (for those renting), as the main reasons why they did not have one. When asked how much they would pay to upgrade from a pit to a flush toilet including ins- tallation, the median response from residents was HTG 5000. This is comparable to the cheapest toi - let, including simple installation, found locally which had a price of HTG 5500. However, with pipe and construction work needed for upgrading, the more typical cost is around HTG 18,500. The residents knew which shops selling construc - tion and hardware supplies also offer toilets, and in the two shops visited, toilets were a significant part of the business. Installation services are also widely available and serval residents knew where to access them. Five installers and masons re - ferred by households earn revenue through seve- ral construction-related services and are skilled in installing toilets and building structures, and some are also electricians, carpenters, and plumbers. All the providers of goods and services interviewed - installers/masons, shops, and empties - rely on word-of-mouth to obtain new customers and vari - ous tactics to retain them. In terms of pit emptying, renters would ask the owner to arrange and pay. Some intended to move the latrine to another place in the yard and bury the used pit, while others planned to contact an empti - er (bayacou) or JEDCO, a sanitation and fumigation company. In some places with shared toilets, there are no arrangements or recognized accountabili - ty for emptying. Interviewed baycous stated they empty between 1-10 latrines per month. They work with between 5-10 people whom they pay per job, and charge around 2500 HTG per drum. In conclusion, households have clear opinions on types of sanitation facilities and they are aware of the benefits these can offer. They can also point to active suppliers of products such as toilets, and ser - vices such as installation and emptying, and indicate barriers and drivers to accessing them. Government and development partners can consider these when making decisions regarding regulations and incen - tives to improve the access to safely managed san - itation, and when promoting related hygienic beha- viors. 6 NOTES ON TOILES AND HYGIENE INTRODUCTION 7 NOTES ON TOILES AND HYGIENE According to the WHO-UNICEF JMP 2015 , urban sanitation coverage in Haiti increased from an estimated 33 to 34% from 1990 to 2015. Thirty-eight percent of urban residents share sanitation facilities with other households, often in shared residential compounds, 20% use un- improved facilities such as lower quality open pit latrines, and 8% do not have access to any faci- lity. City wide sewers and treatment are nonexis - tent and households typically use on-site pits or septic systems. For several years, organizations in Haiti have deve- loped programs based on the construction of sanita - tion systems sometimes accompanied by strategies of community service and awareness and training, sometimes without adequate focus on acceptance and adaptation of technologies behaviors by commu- nities and households. In recent years, DINEPA (National Directorate of Water and Sanitation in Haiti) has developed a stra- tegy to integrate sanitation and hygiene promotion with improving infrastructure and ensuring product availability – all of which was to be grounded in the needs and wants of end-users. In 2014, a national workshop was held on sanitation marketing that es - tablished a working group among interested stake - holders. They began working with the assumption that focusing on user experiences and needs could help programmers and investors introduce interven - tion that would increase hygiene behaviors and sus - tained access to safely managed sanitation. While sanitation programming varies among partners, most interventions now include exploring user pers- pectives when developing the appropriate course of action. The purpose of this assessment was to explore areas to help establish a profile of sanitation and hygiene promotion options by considering i) the availability and perception of sanitation products (goods and services) and ii) constraints and drivers related to accessing and utilizing them. The findings may also be useful in reviewing extrinsic and intrinsic motiva - tions related to sanitation and hygiene related be - haviors. The results generally cover portions of the sanita - tion marketing mix that users interact with: pro- ducts, place (retail and service delivery), pricing, and promotion. This is not meant to negate from the several other frameworks and approaches used in sanitation programing and policy discussions. The sole purpose of framing the discussion in terms of the marketing mix, is to be consistent with the pre - vailing framework currently in use by DINEPA and development partners in Haiti. This assessment builds on studies that have con - sidered household sanitation in Haiti as well as programming experiences. These include pilot condiminial sanitation systems, and the trial of con - tainer-based sanitation solutions in Cap Hatien and Port-au-Prince. 8 NOTES ON TOILES AND HYGIENE This assessment was carried out as supple - mental qualitative exercise to the Résultats du prélèvement des données de l’eau potable et l’assainissement dans l’aire métropolitaine des communes Carrefour et Port-au-Prince, Haïti (Results of the sampling of drinking water and sanitation data in the metropolitan area mu - nicipalities of Carrefour and Port-au-Prince, Haiti), a survey carried out in March and April 2016 among 511 randomly selected households. METHODS The survey took place in a 22 square kilometer area stretching from Mariani 1 in the west to Belair in the east, and from Delmas in the south to the Caribbean Sea and the town of Cite Soleil in the north. House - holds responding to the larger survey were asked if they would be willing to participate in follow up in - terviews. From the positive responses, 31 households were selected based on availability and location. Semi-structured interviews were carried out during June, 2016. The participating households were also asked if they knew of suppliers of sanitation goods and services (retailers, installers, and emptiers) and semi structured interviews were carried out with suppliers in July, 2016. 9 NOTES ON TOILES AND HYGIENE In general, the larger survey and follow up were carried out with low-income residents who re - ported spending most disposable income on con - sumables such as food and airtime. If they had an extra HTG 1200, many said they would seek to increase their incomes by expanding existing busi - nesses, and selling items such as food and cosme- tics, or would pay school fees for their children. A. PERCEPTIONS AND BEHAVIORS AROUND SANITATION PRODUCTS 1. PIT LATRINES WITH SLAB Regarding sanitation, the larger survey of 511 house - holds in the study area found that 84% percent of households have access to a toilet or latrine with 46% sharing with other families (Vera 2016). “It is uncomfortable, dirty, and has a bad smell,” A typical opinion of a pit latrine user by a mother in Centre-Ville, Port-au-Prince When asked about the current sanitation facili - ty, respondents using pit latrines could not think of anything they liked about them. Most households use pit latrines with concrete raised-pedestal slab (see examples in photographs below). Families either sit or squat on the slab, de - pending on how many other they are sharing with, and their family or cultural views regarding the notion of hygiene. When asked to describe positive aspects of the la - trine, all but one of about 20 pit and slab users said, “nothing.” Explanations included smell, lack of comfort and presence of bugs, “I dislike the smell and there are cockroaches in it” said a mother in Bel-Air. Another in Centre-ville stated, “It is uncomfortable, dirty, and has a bad smell,” while another resident of Bel- Air said, “It has flies and smells. We use it because we do not have another choice.” One resident, a mother in Martissant 2A, said that their latrine was at least was preferable to open defe- cation, “It gives me a certain comfort compared to others. I do not have to go to the sea that is full of rubbish and microbes.” FINDINGS 10 NOTES ON TOILES AND HYGIENE TYPICAL PIT LATRINES WITH PESITALS DISCUSSED WITH RESIDENTS FLUSH TOILETS IN VISITED HOUSHOLDS 2. FLUSH TOILETS 3. HOUSEHOLDS WITH NO ACCESS OR UNUSABLE FACILITIES Households with flush toilets were more positive about their facility. Five households used a flush toi - let, connected to an off-set pit, or, in one case, to a pipe than ran to the sea. In all cases, the toilets were flushed or refilled with buckets of water. A mother in Lametin described it the positive aspects, “It has no smell, no bugs and we can clean it easily,” she said, while a head of household in Centre-Ville said simply, “It is conformable.” The one dislike mentioned was from two separate residents who wished that they had a tank connected to a water source to avoid the need to bucket -flush. Households without a latrine, or with unusable facilities were universally negative about their experien- ces. In a household interviewed without a latrine, the mother in a family of four residing in Mariani 2 stated, “It’s embarrassing to say to someone that we don’t have any toilet.” In two households, each in a compound with about 20 residents sharing a single pit latrine, the residents defe- cate in buckets and dump the contents in the hole because the latrine is in too poor of a condition to use, “We defecate in a bucket to protect ourselves against infections and dump the excrement down the latrine,” said one of the residents, a woman in Centre Ville. In this case, the latrine was full, but the residents had been unable to collect funds to empty it. 11 NOTES ON TOILES AND HYGIENE AN UNUSABLE LATRINE 4. HANDWASHING FACILITIES 5. THE IDEAL TOILET Regardless of the level of sanitation, when asked, what is the first thing you do after defecation? all the respondents said they washed their hands with water, and soap or soapy water. When asked why? the universal response was to avoid disease, germs, microbes, or bacteria, “we wash hands with water and soap to avoid catching diseases from germs,” said a mother from Mariani 2 in what was a typical statement about handwashing. The survey of 511 households did not find any house with a handwashing facility (Vera 2016). During the follow up, when asked to indicate where hand - washing took place, only one resident showed the interviewers a place to wash hands with soap and water in proximity to the latrine. Most indicated that a bucket or basin would need to be set up and they often searched for where one might be kept. The soap was usually in a bath or kitchen area, and water was not readily available. All the residents interviewed, indicated that given a choice, they would have a seated flush toilet. The most common reasons given, by seven respon - dents, where because they viewed flush toilets as comfortable, “It would be more comfortable for us,” said a teenager, 17, sitting with her mother in a household that used a pit latrine with a simple slab. Other reasons given were that flush toilets did not smell and were easy to clean. Some resident elabo - rated, “We want a nice one with the installation of an automatic water pump to flush. We would decorate it” said a mother of four and shared un- improved latrine user in Lamentin. “I would want a flush toilet in room with a bay window, along with a large basin and a closet to put our clothes in. Everything would be ceramic. It would be like a second room!” said a mother of two and concrete pit latrine user in Carrefour. Residents indicated that the extra water required would not be a problem, though none could esti - mate the amount that would be needed. The most common barriers for obtaining flush toilets were per - ceived cost and not owning their place of residence, “We are not owner and we don’t have enough money,” said a resident in Centre Villa in a response that was shared by 10 other respondents. One resident suggested that he would install a flush toilet if he could be reimbursed by the landlord, es - pecially if he moved from the property. In six households that were resident-owned and had slab or simple pit latrines, five stated they had not upgraded because they could not afford to, while another resident said they wouldn’t want to share a flush toilet with their tenants in the compound due to hygiene reasons. 6. ALTERNATIVES Residents were asked if they would be interested in trying a dry container-based-toilet, which may pro - vide the same benefits as a flush toilet in terms of comfort and lack of smell. The toilets, such as those promoted by Soil, would be leased to the house, and emptied for them regularly. Fifteen of the house - holds were interested in trying and would be willing to pay an average of HTG 250 per month. One resident said, “It might be better because it does not need water.” Some residents wondered about privacy when using the facilities. 7. PITS Most households did not know or recall when their original pit was dug. One resident had dug a new pit when the old one filled up. In this case, the blocks were made in the yard with other materials pur - chased locally at small shops. Pit depths were re - ported at 8, 25, 35, 40, and 80 feet. 12 NOTES ON TOILES AND HYGIENE RETAIL OUTLETS When discussing where they buy daily items, such as food and detergent, most interviewed residents chose places based on proximity to their homes, with only one mentioning they would travel farther for lower prices. Most residents rarely buy durable goods and did not have opinions on where to purchase them. Fourteen residents knew where to buy a toilet and named markets and shops based on what they seen or heard. Another twelve said they did not know, but mentioned they could ask around to find out. The residents said toilets were most commonly available in shops selling construction and hardware supplies. Toilets appear to be significant parts of these business. In the two outlets visited in the study area, the most common products sold by volume were paint, ceramic tiles, and toilets; and in the other wiring, polish, and toilets. One shop estimated that it sold 50-70 toilets per month, generating about HTG 420,000 in revenue. C. DISTRIBUTION (RETAILING) B. PRICING The retailers visited were family owned, one with seven full- time employees in two branches, and the other 20 employees in one location. They both report generating 60-70% of revenue from households and 30-40% from institutions (mostly government, NGOs) They purchase their stock from distributors including Kay Tchan, Kay Claudy, MSC Plus, and Duralon. When asked how much they would pay to upgrade from a pit hole to a flush toilet including installa - tion, the median response from residents was HTG 5000 (the mean was HTG 5200). This is comparable to the cheapest toilet, including installation, found locally which had a price of HTG 5500. The least expensive toilet found was a High Grade brand toilet with a retail price of HTG 3000. The lowest installation cost, quoted by an installer at Marché Salomon was HTG 2500, however this is without pipe ma - terials and construction work. The typical cost of a flush toilet and installation is closer to HTG 18500. The most popular brands of toilets as reported by local retailers are Corona (Colombia), favored because it uses less water than other brands, and retails at about HTG 3550, and Gerber (China), known for quality, which retails at HTG 6150. The typical cost of installation is about HTG 15,000 and includes work on building or retrofitting the superstructure and installing pipes to an off-set pit. 13 NOTES ON TOILES AND HYGIENE Residents usually consult with a builder or installer before purchasing toilets. As one shopkeeper put it, “ We can refer customers to an installer, but they usually have an installer contacted before they purchase a toilet.” About half of the residents inter - viewed knew of someone who could build a super- structure and install a latrine. They were often des- cribed as, “a friend.” or in one case, “a plumber who lives in the yard.” Those that did not know of an installer often said they would find one by asking people who might know. The five installers and masons referred to by inter - viewed households earn revenue through a number of construction-related services. In addition to insta- lling toilets and building structures, some are also electricians, carpenters, and plumbers. They genera- lly install between 1-6 toilets per month, mostly in households. The installers generally work independently, some - times employing 1-7 workers to help depending on the size of the job. They acquired their skills by appren- ticing with other craftsmen. Two also took part in six month certificate courses offered by the Catholic Church. Shops have installers they engage with a per-job basis. All the installers come with their own tools and pur - chase the materials needed for construction on be - half of the customer, often including the toilet itself. In households who had not yet had their pit emp - tied, about half would ask the owner to arrange and pay for emptying. Some intended to move the la - trine to another place in the yard and bury the used pit, while others planned to contact a bayacou or JEDCO, an emptying service company. In some compounds with multiple residents sharing, it was not clear who would will take responsibility, “The toilet is full now but I am not going to take this responsability. Someone else can do it” said one resident. The survey of 511 households found that six percent had had a pit emptied and two percent had moved the latrine to other part of the compound (Vera 2016). Those households who had latrines emptied usually used bayacous. Emptying was carried out at night and waste was usually trucked away. In some cases, the emptiers dug a hole in the yard and D. SERVICES 1. INSTALLING 2. EMPTYING buried the waste on site. Most would use the same service again and said they were pleased with the job. Two bayacous, recommended by interviewed house - holds, stated they empty between 1-10 latrines per month. They work with between 5-10 people whom they pay per job, and carry out their work from 8.00 pm - 2.00 am. One adds disinfectant to the pit to control the smell as they work. Buckets are used to manually empty the latrines and fill drums. Neither households nor emptiers expressed con - cerns about the how sludge is treated once removed and dumped. Bayokous transport drums by vehicle and take to Titanyen, north of Port au Prince. One emptier said he pays a tipping fee of HTG 1000 to dump at a facility. Another said is dumps in the open in an unpopulated area nearby. The cost to the household is around HTG 2500 a drum and some jobs can cost over 30,000. House - holds who used bayacous reported paying about HTG 4000. As an alternative, households were also asked about their interest in connecting to small systems, such as shared sceptic tanks, where for a monthly fee, they wouldn’t need to be concerned with the waste. About half of the households said expressed a willing- ness to connect, and expect to pay an average of HTG 100 per month for such as service. “We can refer customers to an installer, but they usually have an installer contacted before they purchase a toilet” said a shopkeeper. 14 NOTES ON TOILES AND HYGIENE E. PROMOTION All the providers of goods and services interviewed - installers/masons, shops, and emptiers - rely on word-of-mouth to obtain new customers and var - ious tactics to retain them, “Clients bring new clients” said an installer from Marché Salomon. For installers quality is the key to retaining custom - ers, “Always render good quality of service to the clients, advised a mason-installer.” Another stated, “I keep customers through quality ser - vice…sometimes I have to correct poor workman - ship of previous plumber when repairing a toilet.” For retailers, both mentioned attractive prices as the main method of for retaining customers. “We offer the best pricing. We also treat customers well. We will offer them food and drink in the shop” said a shop manager. The bayacous, had not seen much repeat business, likely due to the long period between jobs, and were relying on new word-of-mouth business. Households also indicated using word of mouth to find goods and services. In exploring other potential promotional channels, all households had access to at least one mobile phone, with most having three. Twenty five of the houses had TVs, and 20 had radios. The most po- pular TV programs mentioned were films, particular - ity anything Haitian, and in two cases war films ( “to learn to fight” , one teenaged daughter explained), football (“for enjoyment and learn how to play”), and cartoons for the children. TV is usually watched in the afternoon and evening depending on when power is available. On radio, households indicated that they listen to the news to stay informed and gospel music. MOST HOUSHOLDS HAVE A TV AND RADIO “I keep customers through quality service...sometimes I have to correct poor workmanship of previous plumber when repairing a toilet” said a installer. “We offer the best pricing. We also treat customers well. We will offer them food and drink in the shop” said a shop manager. 15 NOTES ON TOILES AND HYGIENE CONCLUSIONS 16 NOTES ON TOILES AND HYGIENE EMERGING CONCLUSIONS ON DRIVERS AND BARRIERS FROM THE FINDINGS ARE DISPLAYED IN THE FIGURE BELOW PERSPECTIVES PERSPECTIVES Basic/Improved sanitation and handwashing - products and related behaviors Safely Managing Waste TOILETS /LATRINES EMPTYING SYSTEM CONNECTIONS AND ALTERNATIVES HANDWASHING DRIVERS – Desire for comfort, lack of smell, easy to clean flush toilets. – Dissatisfaction with pit latrines that smell and have insects – Embarrassment with not having a facility or using a very poor one. – Availability of retailers and installers. DRIVERS – Satisfaction with bayacous DRIVERS – Some interest in connecting and paying for system to handle waste – Some interest in trying container-based-dry toilets DRIVERS – Knowledge of health benefits and claims that handwashing is practiced regularly. BARRIERS – Perceived costs of toilets and installation. – Tenancy (for renters) BARRIERS – Perceived costs of emptying – Sharing with multiple families can dilute responsibility, motivation – No expressed concern by households or emptiers concern on how waste is managed once pits are emptied. BARRIERS – Lack of integrated solutions offered from organizations such in government, non-government, or private sector. – Those connected are not concerned if waste is disposed of in the sea. BARRIERS – Lack of handwashing facilities and little evidence of widespread practice. – No immediate benefit stated to carry out regular handwashing 17 NOTES ON TOILES AND HYGIENE In general, households are concerned with and have opinions on types of sanitation facilities they have and the immediate benefits these can offer. They know of, or would be able to find su- ppliers of products such as toilets, as well as ser - vices such as installation and emptying. They are also generally satisfied with the services they have received. They perceive costs and lack of ownership as pre - venting them from having the sanitation facili - ties they desire. Along with the bayacous who empty their latrines, they are not concerned about what happens to waste outside of their compounds. In terms of handwashing, there is widespread know- ledge of the health benefits, yet households do not have a place to wash hands, do not practice it regu - larly, and offered no immediate reason do so. The perspectives of households could be used in de - veloping sanitation and hygiene promotion and for exploring motivations in greater detail. This could include leveraging the desired benefits of sanita - tion to improve participation in infrastructure pro- jects. With households expressing a desire for flush toilets and explaining this in terms of having odor and insect free facilities that are easy to clean, there are opportunities to use this to improve the overall management of sanitation waste. Flush toi - lets, or solutions offering the same benefits of flush toilets, could be offered at reduced cost or financed over time as part of connecting to shared-septic or other small systems. Such programs could build on the lessons of other upgrading programs that have targeted landlords and sought to protect tenants from sudden rent increases. The clear drivers of sanitation stated by households could also be used to develop core messaging and concepts forming the basis of sanitation promo - tion targeting tenants, landlords, and businesses. This could accelerate uptake of safely management sanitation. The promotion could involve suppliers, enabling them to help push the solutions they can offer, and utilize the multiple channels accessed by target audiences. The intrinsic and immediate motivators of hand - washing seem more elusive than with toilet and latrine drivers. While longer term health-related benefits of handwashing are well known, they don’t appear to have translated into sustained behaviors, and more work on finding key motivators is needed. These opportunities can only be realized in an envi - ronment with greater attention to fecal sludge mana- gement, that in the short term considers incentives for emptiers and the sustainability of safe disposal sites, and in the longer term, includes broader sys - tem options, investments, and regulation. 18 NOTES ON TOILES AND HYGIENE ANNEX QUESTIONNAIRES 19 NOTES ON TOILES AND HYGIENE RAPID RESEARCH ON SANITATION PERCEPTIONS HOUSEHOLD INTERVIEWS PORT AU PRINCE 1. INTRODUCTION The overall research objectives are to assess the availability and perception of sanitation products (goods and services). As part of the research, up to 40 household interviews will take place in Port au Prince. 2. COMMUNITY SELECTION At least three weeks prior to the start of field work, IDB and partner should select appropriate areas within greater Port au Prince. Selected areas should be within: • the planned project areas • sample areas for planned IDB WASH survey • areas where coverage of pit latrines is at least 50%ofhouseholds. 3. HOUSEHOLD SELECTION At least 2 weeks prior to the start of the interviews, 40 households using on site sanitation facilities should be selected as follows: 38 housed with latrines: 14 own facility not emptied (4 wet, 10 dry), 12 shared, 12 own that have been emptied, 2 without a facility. As suitable households are identified, confirmations should be sought on their willingness participate in an interview on household lifestyle products. Ideally, the interview should be scheduled when the head of household and spouse are both available. Each household should be given a unique code. NOTES: • the above range of technology types is subject to change based on survey results • The sanitation facilities can be used by neighbors, but should be within the house or household com - pound interviewed, and primarily used and cared for by the household family. • The household may have more than one facility – such as an unused toilet and a pit latrine. 4. NOTES ON INTERVIEW PREPARATION • The interviewers will work in pairs, with one asking the questions, and the other helping to elaborate, ensuring interviews are recorded, and taking notes when necessary. • The interviewers should aim to make the inter- viewees feel at ease and comfortable talking freely. • The interviewers should remain objective, profe- ssional and polite at all times. • The interviewers should try to have the questions answered as completely as possible, by asking “how” and “why” where appropriate. • The interviewers should not correct or argue with interviews even if they disagree with responses. 20 NOTES ON TOILES AND HYGIENE INTERVIEW AND QUESTIONNARIE PART I - GENERAL Starting the interviews: Introduce each other and thank the household mem - bers for agreeing to be interviewed. The interview will focus on questions about their lifestyle products. Inform the respondents that their names will not be linked to responses. They will be anonymous. 1. Number of people in the household 2. Ages 3. Sources of household income 4. Source of water 5. What do you do with used water from the shower and kitchen? 6. How interested are you in having a direct water connection to DINEPA? Why or why not? How much do you think it might cost - For the connection, and per month? 7. Do your rent or own this place? 8. How long have you lived here? 9. How long do you plan to stay? 10. Do you know when the house was built? 11. Do you have a TV, a radio, how many phones for everyone in the house? 12. What do you watch or listen to on TV or the ra - dio? Why? What times? Which channels and sta - tions. Why? [ask for each family member present ] 13. How often/many hours per day do you have elec - tricity? 14. What do you purchase often [food, airtime, su- pplies…prompt them to think about it, go through the days of the week if necessary] 15. How do you go about purchasing these things [names and locations of shops, markets, etc]. Why here? 16. What would you do if you had an extra HTG 1200? Why? PART II– SANITATION [if respondents do not know the answer to a ques - tion, please ask and record why not] Indicate that you’re now going to focus on the toilet and sanitation: – Ask them to see the latrine (s). – Take a photo of the outside of the latrine and of the inside making sure to capture the flooring and hole/seat area. 17. Tell us as much as you know about how the latrine/toilet was installed 17.1. How long ago was it built or installed? 17.2. What did it cost, who built it? 17.3. Where were the materials and components purchased? 18. Who uses the latrine? Go through each family member, any neighbors, others? 19. Show us how it is used? [Ask a child or adult to go through the motions]. Why? 20. [if a raised pedestal] Why do your prefer a pe- destal to a flat surface with a hole? 21. What is the first thing you usually do after using the latrine? Why? And why? [Ask each person present] 22. Describe what you like about the latrine? Why? 21 NOTES ON TOILES AND HYGIENE 23. What do you dislike about it? Why? 24. Please describe your ideal latrine or toilet. Why? And why? 25. Who would you want to use this toilet? 26. How much would you pay for your ideal toilet or latrine? The toilet, the superstructure, installation and construction 27. Why haven’t you installed your ideal latrine? [prompt to give more than one reason] 28. [If not mentioned] would you want a flush toilet? 29. Do you think you can obtain enough water for a flush toilet? 30. How much more water would you need? 31. How much would you be willing to pay monthly to have the toilet connected to a community system that would be maintained for you? Why? 32. Please describe how you would go about insta- lling this new toilet? 32.1. Where would you purchase it? [ask for the names and locations, distance of businesses and suppliers] 32.2. How do you know about them? 32.3. What else have you purchased from the same suppliers? 32.4. What is your opinion of these suppliers – what do you like about them? What don’t you like? [Prompt if hesitant - are they fair? Do they have what you need?] 33. Who would install it? [obtain names and contact information where possible] 33.1. Why would you choose this person [or com - pany] 34. How interested would you be in renting a dry toi - let that would be emptied for you? [show photos] why or why not 35. How much do you think this would cost per month? 36. [ if applicable] – do you know the dimensions of your pit? 37. What materials is the pit lined with? 38. Has the pit ever been emptied? 38.1. If yes: 38.1.1. When was it emptied? [approximate date and time of day or night] 38.1.2. How long did it take to arrange from the re - quest to when the service was performed? 38.1.3. Who carried out the service [obtain names and contacts]? 38.1.4. How much did it cost? 38.1.5. Describe the emptying process and technol - ogies used 38.1.6. How long did the emptying take 38.1.7. Would you use the same people or service again? Why or why not? 38.2. If no: the latrine has not been emptied, 38.3. Why do you think it has never been emptied? 38.4. How would you proceed if it needed to be emptied? 38.4.1. Who would you contact [service, landlord, ask around, etc] [obtain contacts] 38.4.2. How much would you pay to have it emptied? 39. What type of menstrual hygiene products are used in the household [prompt if using commercial product or tissue]? 40. [For the women using these products], How did you come to start using this product or tissue? Why do you use them? Thank the respondents for their time. With their permission, take a photo of the outside of the dwelling. Ensure the household GPS coordinates are noted. 22 NOTES ON TOILES AND HYGIENE PART III - SMALL SHOP OR SUPPLIER Starting the interviews: Thank the supplier for agree - ing to be a part of the interview. This discussion aims to help understand how sanitation equipment is sold and installed. We are not setting up a busi - ness and will not share the information in detail. The project might try to find ways to increase numbers of customers. 41. Please briefly describe your business 42. Please describe the types of customers you have? (income level, gender, age, profession etc) 43. What is the ownership structure (prompt? Single owner and operator, partnership, franchise?) 44. How many employees (if any), full and part time. How many family members, full and part time 45. Are there other branches to this shop? If so, how many? 46. What 3 products sell the most in terms of: 46.1. Revenue 1_____, 2_____, 3______. 46.1.1. Can you give approximate amounts by month or year? If not, percentages of total revenue? 46.2. Volume 1____, 2_____,3______. (numbers of units) 46.2.1. Can you give approximate number of units sold by month or year? If not, percentages of total volume? 47. What is your total revenue per month or year 48. Do your rent or own this place? 49. Can you please estimate how many flush toilets you sell per month or year? 50. Can you estimate the revenue from toilet by month and year? 51. When are people most likely to buy – time of month? Season? 52. How much do the different toilets sold cost? 53. What are the brands of each toilet? 54. Which types to customer prefer? 54.1. Why? 55. Are they made nationally or do you import them? 55.1. If imported where do they come from? 56. Would you be willing to share the names of at least one supplier? 57. What other type of toilets are sold? 57.1. How much do they cost by brand? 58. Do you offer credit or installment plans to customers? 59. Do you install or work with installers? If yes, how is the relationship structured? 60. How do you obtain and retain customers? PART IV - EMPTIER 1. Please briefly describe your business 2. What is the ownership structure (prompt? Single owner and operator, partnership, franchise?) 3. How many employees (if any), full and part time. How many family members, full and part time 4. What 3 services the most in terms of: a. Revenue 1_____, 2_____, 3______. i. Can you give approximate amounts by month or year? If not, percentages of total revenue? b. Volume 1____,2_____,3______. (numbers of ser - vice units) i. Can you give approximate number of services pro - vided by month or year? If not, percentages of total volume? 5. What is your total revenue per month or year? 6. What do you charge for the different services? 7. Please describe the process of delivering the ser - vice (including equipment used, number of people, time service is rendered, where waste is emptied) 8. When are people most likely to need the service – time of month? Season? 9. Who are your customers for the emptying ser - vices (households – age, income level; institutions) 10. What are the major challenges you face? 11. How do you obtain and retain customers? 23 NOTES ON TOILES AND HYGIENE REFERENCES 24 NOTES ON TOILES AND HYGIENE Baumann Gerd, Gingrich Rich, 2004, Grammars of identity/Alterity. Volume 3, EASA Series. ISBN 978- 1-57181-698-6 Díaz de Rada, Ángel, 2012. Cultura, Antropología y otras tonterías. Trotta. Kroeber A.L., Kluckohn Clyde, 1954, Cultural: a cul - tural review of concepts, Massachusetts, Cambridge, USA Leal, Susan, 2013. Cooperative Sanitation in Brazil’s Favelas, Revista Harvard Review of Latin America Winter 2013 Richard Gelting, Katherine Bliss, Molly Patrick, Gabri - ella Lockhart, Thomas Handzel, 2014 Water, Sanitation and Hygiene in Haiti: Past, Present, and Future Am J Trop Med Hyg. 2013 Oct 9; 89(4): 665–670. doi: 10.4269/ajtmh.13-0217 Sebastien Tilmans, Kory Russel, Rachel Sklar, Leah Page, Sasha Kramer, Jennifer Davis, 2015 Container-based sanitation: assessing costs and ef - fectiveness of excreta management in Cap Haitien, Haiti Environ Urban. 2015 Apr; 27(1): 89–104. doi: 10.1177/0956247815572746 PMCID: PMC4461065 WHO/UNICEF Joint Monitoring Programme for Wa - ter Supply and Sanitation, June, 2015. Estimates on the use of Water Sources and Sanita - tion Facilities. Estimates on the use of Water Sources and Sanita - tion Facilities by Urban and Rural Wealth Quintile. World Bank WSP, 2015. Principaux Determinants Comportementaux en Matiere d’Assainissement en Haiti 25 NOTES ON TOILES AND HYGIENE 26 NOTES ON TOILES AND HYGIENE